Friday, 30 November 2007

Wet and wild

Nine emergencies – one cancelled on scene, one refused, one no trace and six went to hospital (one of them after a swim).

During the process of writing, editing and re-editing the book (which should be out now) I didn’t find the time to write regular postings and now I have a backlog of material, all of which is emerging here in retrospect. None of these postings are current and generally represent shifts from the beginning of the month (just in case any of you are trying to track them in real time). I’m sure I’ll catch up and get back into my normal time-zone. Apologies.

This shift started off with a call to a rail station for an 11 year-old female, ‘not feeling well’. I was cancelled on scene because I waited for a member of staff to come and guide me to her but they had already taken the crew, who had arrived after me but at the other side of the station (the correct side, I guess).

At another station later on, I met the crew on scene as they talked to a Scottish girl who had been described as ‘not alert’ when the call came through. She wasn’t drunk but she was acting strangely; giving us the impression that she was mysteriously ill but still managing to smile warmly when a kilted Scotsman (not me) wished her well. He had been her knight in tartan armour (and no, we don’t wear anything underneath, except in England or at parties where women are going to get drunk and therefore inquisitive).

We took her to the ambulance and she feigned a faint inside as we were talking to her. She held my hand a little too tightly I thought and she seemed intense at times. Still, what do I know? Off she went for more attention.

A call to W1 for a 69 year-old man who had collapsed in the street and I was dragged into one of the slowest transfers I’ve ever done. He was from the hostel (he is an alcoholic) at the end of the street he had chosen to collapse on. It was a mere hundred yards away but he was feeble and walked at a snail's pace – an old and very drunk snail. With a heavy shell and arthritis.

He had refused to go to hospital and quite frankly, he didn’t need to, he was just very drunk. The crew had been and gone and I was left to take him home. At first I thought about walking him there but I decided to drive him. It still took us fifteen minutes to get from the pavement to the car.

He was a well-spoken man, obviously of some breeding but he was dishevelled and dirty and smelled badly. Alcohol is a fearsome companion to dignity.

‘Have you had a drink today?’ I asked stupidly.

‘I may have had a few’, he replied.

When I got him to his hostel I walked him to the door and handed him over to the staff. They were not happy and wanted him to go to hospital but I explained that he had refused and was quite adamant about it. They still weren’t happy. I don’t know what they expected me to do. He signed my PRF and I went on my way, happy in the knowledge that yet another hospital bed was free for a genuinely ill person or a drunk with the opposite attitude to this one.

A Chinese restaurant in Chinatown (not surprisingly) next for a 61 year-old woman described as ‘nauseated’. I could see how unwell she was from a distance. As soon as I walked into the place I recognised my patient – the palest woman in the room. She had vomited into a plastic bag on the table. She was with six or seven friends and they were out for a meal together and now she was quite ill, with no apparent cause. I think the restaurant Manager was concerned about the PR this little event was giving his establishment. Diners went about their business all around us, not daring to look up from their plates, lest they see a vomiting woman. I have to say the sick looked just like the meals they were eating - no offence intended, just an observation.

She began to feel faint and I knew she would go if I didn’t move her, so I laid her on the floor and my obs continued while she recovered a little. The crew arrived and after a few minutes and lots of oxygen, she was carefully moved out of the place and into the ambulance. I took the vomit with me and disposed of it. I can sympathise with those diners. It wasn’t the poor woman’s fault, of course but you really don’t want to be eating a nice meal and hearing/seeing someone being ill right next to you.

I have said before that drunken people should be banned from entering railway and tube stations because they pose a danger to themselves and others. My next call was for a ‘male, fallen onto tracks ?electrocution’ at a BR station. He was stupidly drunk and his wailing girlfriend kept pawing at him and crying all over him, like he was a war hero. He had stumbled onto the tracks but hadn’t been electrocuted, luckily. Neither had he been hit by a train. He did, however, have a significant head injury and it was clear he needed to go to hospital urgently.

HEMS were on scene and just ahead of me when I arrived and there was an ambulance crew and a MRU paramedic there too, so he had a full complement of medical professionals on hand. More than the average old lady who has worked hard all her life gets for her chest pain, that’s for sure.

He was in and out of consciousness and was difficult to handle (when awake) because he didn’t understand what was going on or what had happened. His clinging girlfriend was becoming a bore as she continually got in the way of the team as they tried to do their job (I was bag-carrying on this one). He was a very large man; heavy and probably extremely strong and the task of wheeling him to the waiting ambulance proved tiring - I helped for a bit then my colleague carried on alone.

He was put on a trolley bed on the station concourse and taken into the ambulance so that the HEMS team could put him to sleep. He was too difficult to work with otherwise and it’s pretty standard practice in these cases.

His profane, fag-smoking partner had to be told again and again to keep back and eventually the police restrained her until she behaved. He was ‘packaged’ and sent off on blue lights.

I found myself surrounded by a mob of drunken idiots as I tried to treat a 40 year-old man who had been hit by one of those rickshaw type taxis (pedi-cabs they call them) and sustained a head injury and cuts to his face. He was slipping in and out of consciousness and I had an unruly bunch of people jostling me and making stupid nee-naw noises in my ear. What fun the drunken mob has.

The police arrived and bailed me out, thankfully and a crew turned up shortly after them to take the man, who was badly but not seriously injured, to hospital. The jeering adolescents dispersed and I got on with my shift.

A call for a male with a head injury, post assault, turned out to be a no-trace. I sat on stand-by for ages waiting for news of the police arriving but nothing happened. The crew arrived and we decided to do an area search. Nothing. Nobody to be seen with a head injury.

Just as I was leaving the scene, I spotted a young girl standing in the middle of the road. Traffic was swerving to avoid her and she didn’t seem to care. I swung the car around and headed over to her. She was sitting on the pavement with her legs sticking into the road now. I got out and asked her if she was ok.

‘What do you care?’ she said.

‘Well, if you need help I’ll do my best’, I said, not really knowing what I meant.

She stopped bothering with me and threw her bag across the pavement. The contents spilled out and she stood up and stormed off, mouthing something I couldn’t hear. A passing couple asked if they could help and started to pick up her belongings. I ignored them because I was watching her now. I didn’t know her personally but I knew that temperament. We were on the Embankment and she was walking at a fast pace along the wall, looking over into the river. I knew she was going to do something stupid.

I got on the radio and asked for the police, then I drove along the road and tried to locate her but I couldn’t see her and there was no way she could disappear from view if she had stuck to the pavement. A PCSO came running up to me as I cruised along slowly.

‘Did you see her?’ he asked.

‘Yes, she’s run off and I think she’s going to jump in the river’, I told him.

‘She had some sort of big argument with a man down the road earlier and we’ve been looking for her’, he said.

Just then, we were flagged towards a point of access to the river, down steps and directly into the water. She had been found but she was in trouble. The couple who had stopped to pick up her stuff had followed her when I went to call the police and now they were with her. I ran to help and found her in the river about waist deep. The couple were dangerously close to the water trying to coax her back in. I joined them and asked them to step back, which they did. We managed to persuade her that suicide wasn’t painless after all and she clambered out, slipping all the way. We pulled her to the top of the stairs and sat her down.

The river police arrived seconds later and she had an audience for her woes, whatever they were.

Apparently she had waded in and started to swim out to the middle of the river but something (probably common sense) made her turn back. She had been flagging towards the end and had only just made it back onto dry(ish) land. The couple had done a great deal for her and she didn’t even look at them, or anyone else for that matter. Now my boots and trousers were wet.

I ended this shift with an 18 year-old with DIB and I didn’t have to do anything. The crew were already on scene and I was not required. It’s nice to be wanted.

Be safe.

Thursday, 29 November 2007

How to make a cup of coffee whilst on the FRU

Step 1:

Select cup. Get a call, leave cup where it is and hope it's there when you return.
Drunken man on pavement. Refuses ambulances. Call it in. Return

Step 2:

Select a teaspoon to accompany cup. Get a call, leave cup and teaspoon and hope they are still there when you return.
Drunken woman on pavement, sister of drunken man (probably). Crew takes her to a better place. Return.

Step 3:

Put coffee in cup. Get a call, leave cup, teaspoon and coffee where they are and hope they are still there when you return.
Almost get trampled as you attempt to reach a girl who has fainted in a night club.
Attend to her and fifteen of her crazy friends as they mill around crying about her imminent demise. Pray for crew to arrive. Crew arrives (prayer answered).

Step 4:

Pour hot water into cup. You now have a cup of black coffee. Get a call, leave black coffee and teaspoon where they are and hope they are still there when you return.
Get cancelled half way down the road, return to black coffee.

Step 5:

Pour milk into black coffee. You now have a cup of white coffee but you still have to stir it. Get a call, leave unstirred white coffee and teaspoon where they are and hope they are still there when you return.
Arrive on scene only to find a crew dealing with the patient – you are not required. Return to white coffee and teaspoon.

Step 6:

Stir coffee. No need for sugar or the teaspoon any more. Wash teaspoon. Get a call,
leave unsweetened white coffee and hope it’s still there when you return.
Get cancelled before you even get in the car. Don’t forget to change status to ‘away from vehicle’ or ‘at station’ or there will be trouble.

Step 7:

Put coffee to lips and sip. Get a call, leave single-sipped unsweetened white coffee and hope it's still there when you return.
Treat old lady for a fall in which she has bruised her head. Wait for crew to arrive and leave when they are happy to deal. Return to single-sipped unsweetened white coffee.
It’s cold. Damn!

Step 8:

Put coffee in microwave for 30 seconds. Return to sipping. Maybe allow yourself to relax a little and start drinking it properly without fear of another call coming through.
Get a call, leave semi-sipped, almost drunk coffee and hope it’s still there when you return.
Treat no-one ‘cos it’s another bloody hoax. Return to find coffee’s gone. It’s been washed out or finished off, you’ll never find out which.

Be safe.

Wednesday, 28 November 2007


Seven calls – one refused (then agreed) to go, one detained under the Mental Health Act, one false alarm and four taken by ambulance.

I think, personally, if I got clipped by a bus and survived to tell the tale – I mean I was walking, talking and full of beans – and I found myself on the corner of the hospital grounds, I’d probably walk into A&E rather than call an ambulance and wait until it arrived. But that’s me.

My first call of the shift was for a 44 year-old man who had been knocked, ever so slowly, off his motorcycle by a bus as it turned a corner. He landed hard on his right shoulder and had a little discomfort there. I was on scene within four minutes and the ambulance was a minute behind me. The system was working...

I arrived to find the man standing on the corner of the hospital with a small group of witnesses and concerned citizens. The bus driver was there too and there was an expectant glance in my direction as I pulled up.

I got three questions in (what happened? Are you hurt? Is anybody else hurt?) before the crew turned up to take over. They did their cursory check (he had no neck pain and hadn’t been unconscious) and the attendant walked him round to the A&E department. It was much faster than sitting him in the ambulance and travelling all the way around the one-way system.

Then off to see a 29 year-old female who was ‘collapsed outside a cafe’. A call like this rings a bell. Usually, someone ‘collapsed’ outside a public place in the middle of the morning is (a) drunk, (b) drugged up or (c) gone before I arrive. This girl was from the (b) category. She was slumped in a chair outside an Italian man’s coffee shop in trendy Covent Garden. It was around 11am and there was a lot of passing trade...passing by. She was obviously putting his customers off and something had to be done about it – dial 999 and ask for an ambulance.

I woke her up from the stupor she was in and she warmed to me immediately. Her name was 'Trish'.

‘F**k off!’, she requested.

‘You can’t sleep here. Sorry but you have to go somewhere less public or we’ll be called out again for you.’

‘Leave me alone, I ain’t doin nuffin wrong’, she said, eyes half open (or shut).

She had taken heroin and was sleeping it off before she travelled the area looking for her next score. That’s the lifestyle she wanted. She wasn’t 29 either, she was probably only 20. Her habit made her look older.

I spent twenty minutes persuading her to move and eventually she agreed to go if she got a free cup of coffee. Strangely, the Italian proprietor was only too happy to oblige. I thought about fishing for one myself (it wasn’t offered) but then I didn’t want to spend any more time with my new druggy friend.

I left after cancelling the ambulance and made my way back to the station. As soon as I parked up I got called back to the same location for a ‘female, collapsed in street’. This time she was described as a 16 year-old - somebody needs to go and get their eyesight checked. The MRU was preparing to go too and I told him that I thought this was probably the same girl from earlier. I went with him to check it out and sure enough, it was my friend ‘Trish’ from a mere thirty minutes ago. She was starting her career as a frequent flyer.

She was asleep – standing up in the middle of the pavement. People were consciously avoiding her as they walked by; some of them were crossing the road to consciously avoid her. The ones who weren’t consciously avoiding her were bumping into her because they thought she was moving. She wasn’t. She was London’s first live pavement statue – ‘the sleeping drug addict in rags’.

I felt sorry for her because she was so young but I had tried to reason with her about the way she was living and all I got was abuse and a hard-lived stare from her red, watery eyes. I’ve had that stare hundreds of times and it means nothing is going to change. Drugs control people.

The ambulance crew arrived and I managed to persuade ‘Trish’ to go aboard the good ship LAS for some free ‘treatment’ and a bed until she had snapped out of it. The police showed up too because her pavement antics had generated a lot of calls from the panic-stricken people of that area. As I sat in the car doing my second lot of paperwork for her, the LFB turned up and four or five fire-fighters fell out of the truck. I was beginning to think this was turning into a comedy of errors but realised that they were on a separate call. They filed past me, directly to the wrong address (I knew that because someone was calling to them from a completely different building). I smiled and sympathised because that happens a LOT to us.

A 41 year-old female with ‘difficulty swallowing’ was my next patient. She was in her office and suddenly felt as if she was on a ship; her balance and co-ordination went. She couldn’t swallow properly and a headache developed. She thought she was hypo (although she isn’t a diabetic) and went to get a sandwich but during the trip to and from the shop people were helping her as she flopped and wobbled along the pavement. She told me she felt and probably looked drunk.

The crew arrived to take her to hospital and I wondered if there was something neurological going on.

I was on lights and sirens to my next call - a 34 year-old man who was half-naked in a tube station – when the car in front of me pulled in to let me pass. Unfortunately he pulled in at 30mph and the driver of a parked vehicle opened his door at the precise moment in which he carried out the manoeuvre. I watched as the first car ripped the wing mirror clean off the second car, almost injuring the driver as he tried to step from his vehicle. I passed them by, saw that the stationary driver wasn’t hurt and carried on to my destination. Every now and then minor bumps and shunts take place in front of us as a direct consequence of our need to get through traffic. This is one of the reasons I don’t like FRED and his cancelling habits. If an accident is going to happen, I’d much prefer it if I was completing a call and not half way to one before being stood down.

Anyway, I got to the tube station and the police were surrounding a drug addict who had stripped off for the benefit of the public. There were children around, so it wasn’t wholesome family entertainment. He was completely off his head and sang at the top of his lungs before threatening the cops if they tried to arrest him. 'You'll never take me alive coppers' doesn't sound the same when you are a skinny, half-naked Cockney drug addict with amatuer tattoos on your arms.

The crew arrived and we stood back and considered the options. He was far too unbalanced to stay in the public domain but he had no clinical problems – he was just mad. I suggested we take him to hospital and use the Mental Health Act to ensure that he went. In other words, he was going whether he liked it or not. So, Section 136 was invoked and he was duly restrained for the trip to hospital – I should point out that he was only restrained because he became aggressive and threatened violence; otherwise there is usually no need to cuff someone for the purpose of this Act.

I travelled with the police and the singing nutter and watched him being led/dragged (he wasn’t willing) to a small, private room with a television. Well, one-way television – CCTV.

The false alarm was another of those ridiculously inaccurate calls for ill babies that we sometimes get. A one month-old baby was in cardiac arrest, so the ambulance, the MRU and me flew to the address, stormed in expecting the worst and were confronted by shocked parents and a hot baby. Babies with temperatures are not in cardiac arrest. Please parents...check your baby's breathing...check its reaction to you screaming 'Oh my God, my baby's dead!' If the baby moves at all, it is probably NOT dead.

My last job was to a 24 year-old female with a history of epilepsy and a recent problem with medicines not doing their job. She had fitted for 20 minutes, according to witnesses and by the time I arrived she was recovering, although still a little post ictal. She was confused and kept trying to get up (this is the usual pattern of behaviour in the end phase of epilepsy) and it took a lot of persuasion to keep her still until the ambulance arrived and the crew took her to hospital.

Thus, another shift completed and, although the day didn’t involve any drama, it was busy and kept me sane - even if others weren't.

Be safe.

Tuesday, 27 November 2007

Medical mole

Eight calls – one refused, the others went by ambulance.

A fairly routine sort of shift which started off with a 37 year-old male who had a near faint in E1. The crew were already on scene and dealing, so I confirmed my ‘not required’ status, turned around and headed back to my own area.

A 50 year-old pedestrian who had a physical argument with a lorry came off worst with a fractured ankle – but he’ll live. As soon as the crew arrived I handed him over to them and he was taken to hospital for an x-ray and possibly a few pins.

For some reason, there are shifts that are coincidental in nature. I mean, most of the time when I am writing a post I run a theme through it. That's usually only possible because of the nature of my work. One day I might get more chest pain patients than another, for example. Most of my patients (or all of them) were 80 year-old men...or I find myself working near railway tracks, mostly underground for almost the entire shift.

If you have chest pain – I mean proper chest pain – don’t ignore it for days before calling an ambulance. A 55 year-old female collapsed at Kings Cross station because she couldn’t cope with her chest pain any longer – she had suffered it for three days. Her husband was anxious and annoyed because he had been kept out of the loop. A Motorcycle Response Unit (MRU) was already on scene when I arrived, so I helped guide the crew to where she was. She was quickly loaded onto a bed and wheeled out to the ambulance. Her ECG was abnormal but not, thankfully, immediately worrying.

Reactions to food can affect people quite suddenly. My next call was to a 35 year-old woman who collapsed and passed out on the floor of the toilet at her workplace. She had just eaten lunch and was now covered in an erythemic rash. She was conscious when I arrived and denied having any allergies. She confirmed that she had eaten a sandwich and it’s possible that something in it caused her sudden collapse. The rash is insignificant but the sudden collapse isn't, so she went to hospital for further checks.

A 79 year-old with a cardiac history and who really should know better, nursed his chest pain for 2 months on and off before finally giving in and calling an ambulance, or so he claimed. When it became too uncomfortable to bear he tried his GTN and this brought about an immediate drop in blood pressure and collapse. His family, tired of his stubborn nature, decided enough was enough and called us out.

He lived on the millionth floor of a tower block that was in mid-renovation. Scaffolding covered the building and workmen were sawing, hammering and generally being noisy all around me when I arrived. The lift, although working, had to be the slowest in Europe. It seemed to take forever to get to the floor I needed. Thank God he wasn’t having a heart attack.

He was very pale and looked uncomfortable. His collapse was probably solely due to the GTN and his ongoing chest pain was probably unstable angina, so he was taken to hospital as soon as the crew arrived.

I went to the newly opened St. Pancras station for a 76 year-old man who had fallen and sustained a head injury on the station platform. He had a nasty cut to his scalp but the bleeding was under control and an off-duty paramedic from another service was on scene to lend a hand before I arrived.

I chatted with the patient and looked at his injury. He hadn’t been knocked out, he had no medical problems and he certainly hadn’t been drinking alcohol. It wasn’t until I looked down at his feet that I realised what had happened to him.

He was running along the platform edge (well, shuffling fast – his gait was quite unstable) when he clipped the cobbled part of the platform edge, spilling over onto the concrete as a result. He was wearing flip-flops; loose sandals. Hardly practical and his toes must have been freezing.

He refused to go to hospital, so I cancelled the ambulance. That didn’t stop two crews showing up on scene, however.

Still on a railway theme, I found myself at Victoria underground station next. I was there for a 30 year-old female who had collapsed on the platform. The place was heaving with commuters and I was being edged out towards the rail – it was quite dangerous trying to get through them. When I got to my patient she was sitting on a bench with a member of the underground staff and an off-duty doctor. She was hyperventilating. She told me that she had nearly fainted on the train after experiencing stomach pains. I reassured her and began the process of slowing her breathing down as we waited for the ambulance crew to fight their way towards us.

Finally, a 31 year-old male with chest pain at yet another underground station. This time, however, he claimed his chest pain wasn’t actually a pain but more of a ‘weird feeling’ in his stomach. So neither chest nor pain, in fact. He went to hospital for the reassurance he needed, if nothing else.

I was glad to be back in fresh air (sort of) after all that.

Be safe.

Monday, 26 November 2007

Hemingway and Heroin

Five emergencies – one treated on scene, four taken by ambulance.

I did a lot of research into childhood obesity when I was at University. My dissertation concluded that the current trend would lead to much younger people, perhaps even kids at high school, having heart attacks and strokes as a result of their ludicrous eating habits. I wrote about this in 2004 when the obesity ‘epidemic’ wasn’t even vogue and Jamie Oliver was just touching on the subject of healthier school dinners (he has since been screwed over by the Government) but now the subject has become one of the biggest talking points in the UK.

Today I heard a story on the radio of a woman who became impaled through the buttocks on a railing which penetrated so deep it should have severed major arteries and damaged vital organs. However, this didn’t happen because she was so fat the mass of her buttock actually saved her life. Her boyfriend, who is obviously happy that she survived, wrote to her favourite fast food chain, KFC, thanking them and offering to work for them for free as a reward for ‘saving her life’.

I should have laughed but I was too shocked. This isn’t about being fat any more, it’s about being too ignorant to realise the damage that is being done. I’ve even seen a report in which new research suggests that being fat means you might live longer! Give me a break!

What next, someone who deliberately gets fat for the sake of art? ‘I’m expressing myself through the medium of pizza’.

First off, a 22 year-old pregnant woman with abdominal pain. Sometimes the pain is normal, sometimes it’s sinister, so we always take it seriously. An ambulance was already on scene when I arrived, so I was surplus.

Then a 43 year-old solicitor described as ‘not fully conscious’. He was on the floor of his little office when I arrived but he got himself up as soon as he saw me. His mum had called the ambulance because she was concerned about him. He had recently started drinking heavily and was generally depressed. He was on a slippery slope and didn’t seem to want to help himself.

‘Have you been drinking today?’ I asked, looking around at the empty bottles lying on his desk.

‘Yes. I’ll drink anything I can get my hands on’, he replied.

I think the doctors, who have diagnosed him as having ‘anxiety syndrome’ have only scratched the surface. The man is falling apart.

A call to the City for a 38 year-old man with chest pain later on in the day. He was with his two friends, both doctors (one medical, one not) and a report of ‘diminished breath sounds’ on his right side was given when I met them. He had been playing football and fell on top of someone’s knee. His chest had taken the brunt of the force, so a rib could have cracked and penetrated a lung. If he had a pneumothorax, it may develop and become potentially life-threatening, so he was taken to hospital quickly.

I treated my next patient where he lay, on the bedroom floor of a hostel. He was a 59 year-old man who had just taken more than his fair share of heroin. He was unconscious when I found him and his breathing had become very slow and shallow. He was on his way out. This was the second overdose I had treated at these premises and no doubt one day, I will find one of the residents dead.

I injected narcan into the man’s vein and waited a few minutes for him to recover. I ‘bagged’ him to support his breathing and he began to come out of his little coma. Within ten minutes of arriving, he was sitting up and talking.

‘That’s the last time I do that’, he said.

I wanted to believe him but I had more chance of seeing Santa. He refused to go to hospital, which is fairly normal for this kind of call and he related his life story to me while I took his details, re-checked his obs (heroin has a nasty habit of kicking in again after the narcan has done its job) and waited for evidence that he was stable.

He had lost his wife of 20-odd years recently. She had died violently, by his account and he had never recovered from watching her go. I felt sorry for him but I also knew that where he was, in the depths of drugs and alcohol, might be impossible to escape from.

I looked around his little room; he shared it with one other. He had a crisp clean shirt ready on the bed, almost as if he had an interview to attend and his clothes were generally tidy. It was his reading material that attracted my attention most, however – among the books on his shelf were a couple of Hemingways.

My last call of the shift was to a 55 year-old male, ‘collapsed’. He was very pale when I arrived and he vomited as soon as he was sat up from his slumped position on the floor. The crew were already on scene when I got there, but only by a few seconds. There were no access ramps (this was a university building) at all and we had to take the trolley bed up to the 4th floor and put him on it. When we got back to the ground floor, we discovered that the only lift big enough to take the bed, the goods lift, was out of order. Now we had no way of getting him out of the building without lifting him up steps. The trolley beds are extremely heavy and not designed for lifting, so the prospect of injuring our backs to get him to the ambulance did not appeal to us.

Luckily, he recovered enough to transfer from the bed to the chair and we got him out that way. I still had to lift the trolley bed out of the building but at least it was lighter without the patient. I was very surprised to see that the place, which is fairly modern, had no disabled access. I thought it was illegal these days.

On my way home I saw a cyclist cross my path wearing a hi-vis tabard upon which was printed one word – POLITE.

One smile for the day then.

Be safe.

Tuesday, 20 November 2007

Nothing too serious

Seven calls – one false alarm, one assisted-only and one conveyed. The others went to hospital by ambulance.

An 80 year-old Swedish woman fainted in a restaurant in Soho. The staff called an ambulance for her and I arrived to find her sitting outside (for fresh air) with her four daughters. She had no cardiac history but had fainted a few times in the past. At her age, it’s worth investigating before making assumptions, so she was taken to hospital. I saw her later on in the A&E department and she seemed to be recovering well.

An RTC involving a van and a pedestrian turned out to be a waste of time because the ‘victim’ walked off in a drunken rage after being clipped by the van (the driver of which stayed on scene for the police). I was about to leave when a police officer asked me to go and check the man out. He was around the corner and had been stopped and asked to wait for us. The ambulance had been and gone, so I obliged.

He was an obnoxious drunken fool of a man and he insisted on smoking and belching his way through an abusive volley of requests to be ‘left alone’. I left him alone and so did the police, who were none too happy with his behaviour but he just wasn’t worth the paperwork. He wandered off and we watched him go. He staggered a lot.

Into Theatreland for a 10 year-old girl who had fallen awkwardly when she tried to climb over the seats with a handful of ice-cream. She lost her balance and fell backward, cracking her head hard on the back of a narrow chair at the end of an aisle. She also had a sore arm (her ice cream holding arm).

When I arrived her mother and a member of staff were sitting on the fire exit stairs just outside the seating area. I could hear the show in full swing behind us. She was weepy and in a little pain but otherwise fine. She had no obvious breaks or bleeds and her sense of humour was intact (I tested it with my crap jokes).

I decided to take her and her mum to hospital in the car, rather than have her go through the ordeal of sitting in a big ambulance with even more strangers standing over her. Children can become quite unsettled when we arrive in droves.

Mum agreed and we went to hospital, chatting all the way about how much they loved London and how sorry they were to have missed the rest of the show. The staff member had given the little girl a signed photo from the star of that show.

‘When he heard you had been in accident, he came off stage to sign this just for you’, he told her.

Of course he did. It was a nice gesture though.

I have met a few boxers in my career but my call to a 46 year-old diabetic man, '?hypo', was my first introduction to a heavyweight champion. He is retired now and works as a doorman but he is a BIG fella.

His problem wasn’t related to his diabetes; he had a badly swollen eye and arm. It looked as though he had reacted to something, although he denied any allergies. He moved slowly as he lumbered to the ambulance and he was as gentle as a lamb. There are some large men out there with quiet voices; it’s a paradox to me.

I have only given penicillin twice for suspected meningitis. Many of the calls we get for this turn out to be nothing more than a ‘hot child’ or someone with the flu. I was sent to a 14 year-old boy who was suddenly unwell. The call description included the words ‘? meningitis’.

I found him lying on his bed; his mother and brother were in the room with him. There was no ambulance immediately available and I had just gone through a long tailback of traffic caused, ironically, by the police as they rounded up gangs of teenagers who had been fighting earlier. I knew I was going to be with this patient for some time without backup.

He had a high temperature, a widespread, non-blanching rash, photophobia and a throbbing headache. I carried out little tests for Kernig’s sign and Brudzinski’s sign and got some positive reaction, although they weren’t definitive. But the most important piece of information came from this mother.

‘His brother was in hospital with meningitis last year’, she told me.

A familial history of meningitis increases the likelihood of a genuine case, so I prepared to administer benzylpenicillin. I couldn’t go beyond IV access, however – his mother told me he had a positive allergy to penicillin. This was a problem because the earlier the antibiotic is administered, the greater the chance of success. I had to wait twenty minutes for the ambulance crew to arrive before I could get him to hospital. It was an uncomfortable wait but the boy remained stable and in good spirits.

It was a few hours before I went out on my next life-saving mission. This time it was for an 18 year-old male ‘unconscious after drinking’. I found him, surrounded by his mates, lying on the pavement.

‘Do you want to go to hospital?’ I shouted in his ear.

‘No, I need to sleep!’ He responded with a start.

So much for being unconscious then.

I got him to sit up, then stand up, then walk away to find a taxi to take him home, friends in tow. Another couple of hundred quid of tax-payer’s money saved, I thought.

My last call of the night was to a 50 year-old with reported DIB. He didn’t have anything of the sort – he was having a panic attack. He was in his hotel room with a friend and had collapsed in an emotional heap after a ‘phone call. He didn’t tell me any of this, I asked him. I use the same question whenever I see an obviously emotional patient: ‘Have you had bad news or are you upset about something?’

He had and he was. The crew took him to hospital anyway. I went home and left humanity to itself while I slept.

Be safe.

Have a laugh - its free!

I saw this very strange and oddly appealing film on my Swedish friend Djina's website. I thought it was medical enough to include here. Be patient with it.


Monday, 19 November 2007

Too late

Eight calls – one no trace, one cancelled on arrival, five required an ambulance and one didn’t make it.

I’ve written a chapter in my book about the access difficulties we have with many of the housing estates (mainly council) in our area. The chapter, ‘Horrible Housing’, details a few calls that have been made difficult for us and the patient because we couldn’t get in quick enough due to heavily secured gates, doors and barriers – often on every floor. In the book, I suggested that sooner or later, these obstructions, however necessary for the security of the residents, would lead (indirectly or not), to the death of a patient.

My first call this morning was to a 78 year-old male having an asthma attack. That’s all I got on my screen, nothing else. The address was a minute away and I got there in plenty of time to make the ORCON Gods smile. But there was a problem. I had arrived at an address I knew only too well. It was a veritable fortress of council flats, stupidly (and I suppose in its day artistically) layered so that each block contained a certain number of flats and each level was ‘crazy paving’ layered for aesthetic reasons. The whole place is a shambles and once you locate the actual block that houses the flat you are going to, there is an immediate obstruction to entry. The front door.

I stood there pressing the buzzer for the relevant flat. Nothing. I called Control and asked them to ‘ring back’ the patient and ask him to let me in. Still nothing. I was waiting outside this heavily built door for three minutes. I pressed the Warden buzzer, the Service buzzer and a few other buzzers at random and all I got was an ear-piercing scream from the Warden alert system. A scream that is supposed to let the Warden know I am waiting there. He or she must have been a ghost because I never saw him/her.

Five minutes passed and the crew arrived. I was glad to see them. They were friends of mine and they would soon be valuable to me.

I was standing at the door with everything I needed for an asthma attack. When the crew got out of the ambulance, one of my colleagues held up the FR2 (defibrillator) and asked if I needed anything else. I said no and they approached.

‘Why the defib?’ I asked.

‘We got this as a query suspended’, came the reply.

Now I was confused. I hadn’t been given an update and when I last spoke to my Control I was told they were ‘calling the patient back’. I decided to grab my paramedic bag, just in case. I should carry it with me every time but, with everything else I have to take in it becomes impractical, when working alone, to do that for every job, so I try to assess what I might need based on the call details and my gut feeling.

Now the three of us were waiting outside the front door, pressing buzzers. It was at least another three minutes before we finally got in. Control called me back just as the door release sounded – they told me that they had tried to ring back but the patient didn’t answer. I told them we were in now anyway.

We made our way to the relevant floor and stepped out of the lift. Now which way was it? This place is a nightmare and finding the right flat is hit and miss, regardless of the numbering system. We walked to the right and found the flat immediately – not because it was easy to locate but because the patient was lying on his back, half in and half out of his door, suspended.

My colleague checked him as I prepared for a resus. He was pulseless. From that moment, our focus was to try and save him. He must have collapsed after buzzing us in. We worked very hard to get him back but he was in persistent PEA throughout and unless the cause is identified and reversed it is impossible to save someone in this condition. We were in the middle of the corridor, resuscitating a man on the floor and not one neighbour - not one - bothered to peer out to see what all the commotion was about. Society is going down a very deep drain.

I tried adrenaline, atropine and Salbutamol, which was given via the bag-valve-mask by the crew but nothing changed. He had a bradycardic rhythm but remained pulseless.

I couldn’t intubate him because he had a grade III airway and all I could see was part of his epiglottis. I made three attempts to secure it but we were forced to continue with basic airway management and that’s how we transported him.

He arrived at hospital in the same condition as we had found him and the resus team continued what we had started but they stopped after ten minutes and ‘called it’. The man turned out to be in his late 60’s and had been to hospital a few days earlier with breathing problems. Sooner or later his asthma was going to get him. Today it did but I can’t help thinking that the delay at the front door of that ugly building had contributed somehow to his death. Getting to him five minutes earlier may have meant he was still conscious. Ten minutes earlier and he was going to get to hospital alive. Whether or not he would have survived in either of those scenarios will never be known.

And so my day started badly (no disrespect to the patient, of course). I was sent to a 35 year-old male having a ‘panic attack’ a few hours later and I felt no sympathy for him. I was professional and smiled when dealing with him but I couldn’t see his emergency. I let the crew take him to the ambulance and I went back to my station.

A call to north London next and I was with a crew outside yet another locked door. This time, it was the front door to the flat itself and there was no reply to our knocks and shouts. The call was for a 29 year-old male diabetic who was hypo and couldn’t move. We were also told he may have dislocated his knee, although quite how he did that I don’t know.

The police had been called to assist us with entry and call-backs were going to voicemail, so concern was growing. Control called me to say that the police had no units to send just yet, so we decided to force the door ourselves. My colleague lifted his leg and threw the weight of it towards the door. Just as it neared the frame, a shadow appeared on the other side of the glass and the door clicked. My colleague must be a ballet dancer in his spare time because he somehow managed to stop at the most critical point, where the leg muscles are committed to finishing the job, and drop his leg back to the ground without making any contact with the door at all. It was a close one though.

The door opened and a young Chinese girl peered out.

‘Ambulance’, we said, rather obviously.

‘Yes?’ she asked as if we were selling her some free healthcare, door-to-door.

‘Did you call an ambulance?’ my colleague asked.

‘No, I didn’t’, she smiled.

We double-checked the address and confirmed it with her (as if she didn’t know where she lived) and all was in order...or so it seemed.

‘Is there anyone else in the house?’ I asked.

‘No, I’m alone.’

‘Is there a diabetic in the household?’

I was expecting her to say ‘look, dumbass, I’ve already said I’m alone, so why would I now say yes I have a diabetic with me?’ Luckily she understood what I meant.

‘No, nobody is diabetic who lives here.’

The young Chinese don’t generally live alone. They live in couples and groups, so I figured it was a logical question. It still didn’t help us though.

I called it in and Control updated me, saying that the patient had called again to say he was at a different location, miles from this one and that he used to live there but was confused. I’ll bet he was. The same person had given three separate locations for where he was, so the call was cancelled as a hoax until proven otherwise.

A regular patient called us from King’s Cross station to report that he was having a fit. I went to see him and he was sorry that he had called us but he felt he might have a seizure. He has a history of epilepsy and diabetes but I have never had to treat him for either – he always seems to be ‘feeling funny’ and that’s enough for him. It’s cold and damp on the streets, so he went to hospital for warmth and sympathy.

I was cancelled as I arrived on scene later on when I responded to a collapsed female in a large department store. She had obviously recovered and decided an ambulance was over the top.

Speaking of large department stores, I see that the Selfridge building has been entirely secured with netting up on scaffolding, presumably as they make emergency repairs to their roof. At least the Christmas shoppers below will be safe from any falling debris. The management are being pro-active and responsible.

There seems to be a rush to get as many of us out to the shops as possible for Christmas. What’s going on? Most of the Christmas lights are now on. What about Global warming? How come we are being asked to save energy by switching off the lights and every greedy giant corporation can carry on burning it up? I say every shop and office building should switch its non-essential lights off during the night. Who on earth cares where the nearest tile shop is at three in the morning anyway? Switch your damned shop signs off!

A hotel near Marble Arch for my next call. The patient had severe back pain which went into spasm whenever he moved. He was a 38 year-old Egyptian man with a wicked sense of humour, despite his discomfort. He had been lying on his room floor for three hours before calling us out. The hotel staff told me that they had called an ambulance hours ago but had been told nothing was available but I’m not sure how true that is; it seems very unlikely.

Anyway, it took half an hour, three of us (me and the crew) and 5ml of morphine to get him out of the room and into the ambulance.

The weather is cold, did I tell you that? Well, another regular came out of the woodwork for his trip to hospital. Mr. Colostomy bag. This time he claimed his bowels were leaking out of him. They were, kind of, but then they always are – he doesn’t take care of his stoma. Neither does he care about us or the inconvenience he puts emergency crews to.

I wasn’t taking him to hospital in the car because he smells very bad and I had to consider the possibility that a decent member of the public would have to travel in it immediately after him so I waited for the ambulance to arrive.

When the crew got to me, I had been with him for twenty minutes and had heard all of his grievances. I had remained fairly passive with him because he has a reputation for throwing his faecal matter at us when we annoy him but he still got the riot act from the crew, who took him to hospital...again (he’d been in and out twice so far today).

I left the scene feeling guilty that I had passed this on to my colleagues and I’m sure they will repay me in kind.

My last call made me late. I was dragged up to Oxford Street for a 22 year-old male who had been fitting and had a leg injury. He was at a tube station and was lying on the bench when I arrived (the crew were on scene ahead of me but only because they cheated and cut me up on the drive in):-)

The patient was in his 40’s in fact and had not been fitting. He was a homeless man with a painful knee and it was obvious to us all that he was looking for a warm hospital bed. He did a lot of moaning and groaning about his knee. He did a bit of writhing about too. There was no pain on his face though. Not real pain.

‘So when did your leg start giving you trouble then?’ my colleague asked.

‘In the 1980’s’, said the man on the bench.

Be safe.

Friday, 16 November 2007

Right said FRED

Nine calls – three false alarms, one refused and five genuinely in need.

The one aspect of FRED, our automatic despatch system, that riles me most, is its ability to run you off your feet without actually having you do any work. I received at least a dozen calls from FRED on this shift, all of which were cancelled at the station. All I had to do was go outside, open the car and press the button to reset the system. Back and forth I went for the best part of an hour. Its most damaging effect is psychological. There is no way you can settle down to rest after a heavy shift when you are constantly waiting for the next call from FRED. I think we are all entitled to unwind a little between jobs, especially when it is busy but this system sends calls to your MDT regardless of your state of mind. It’s a computer and it doesn’t give a toss about how wrecked you feel.

FRED is like a shark to me (it’s a loose analogy but it fits with my way of thinking). It hunts for the nearest available FRU to the call and sends the job down to its MDT. When it locates an even nearer vehicle, it cancels the first FRU and sends the job to the new FRU and so on. I believe it can continue doing this until it has literally ‘relayed’ the call from one FRU to another all the way down the line. All those other units have been cancelled at station (so the poor sod has to go outside and press the button) or in the middle of the journey (so traffic and pedestrians have been inconvenienced for nothing – not to mention the potential risk that the driver undertook when he started running on blue lights and at speed to get there).

So, my shift was busy and frustrating at the same time. Thanks FRED.

Having said all that, I did have a busy night. An 80 year-old woman with DIB and psychiatric problems was having a panic attack when I arrived (thus the ‘breathing problems’).

‘Please don’t take me away!’ she begged.

I don’t know what the last visit to hospital cost her but she wasn’t prepared to pay the price again. It took me a while to calm her down. I was sure she was much younger than the age I was given but I didn’t like to ask at this stage, so I waited for a crew to take her to hospital. She had settled down a little by the time they arrived and lots of reassurances from the crew persuaded her to go.

Then a 19 year-old female with DIB and chest pain. I was sent 3 miles for this one, only to find a crew already on scene and dealing with her. I was, of course, not required. I was also, of course, out of my own area and thus no cover was available from me.

Another DIB and chest pain combination. This time it was a 72 year-old female. She had emphysema and a history of MI, angina and chest infections. She had taken her own GTN for the pain and it had brought some relief, which is a good sign. Her angina was probably playing up. Her DIB persisted, however, so the crew treated her and took her to hospital.

A 30 year-old ‘collapsed in street’ got up and walked off when he saw the police coming towards him. I arrived just as he left. I wonder what his plan was?

I was no sooner back at station when I received another call for yet another 3 mile hike. This time I was going to see a 45 year-old man who had collapsed in the street. When I got on scene he was lying very still in the middle of the road. A number of people were standing over him, not doing much. He looked dead. I thought I was heading towards a suspended patient.

In fact, he turned out to be the first of what will be many ( as soon as Christmas gets close) of my decently dressed, well fed, well paid, drunk and extremely rude patients. He opened his eyes when I spoke to him and he stared at me with the glassy eyes of a middle-aged doll on crack. He was a suit-wearing drunkard and they are the worst kind in my book. They have an arrogance that comes with being a tax-payer who is utilising the services at his or her convenience, without actually needing to. They have that 'I pay your wages' attitude about them.

‘Why are you lying in the middle of the road?’ I asked him.

‘I dunno. I’ve had a few drinks. What are you anyway?’

I would have preferred him to ask ‘who are you?’ It would have been a friendlier start. Should I reply with ‘I am a London Ambulance Service Paramedic. Highly trained and professional and your willing servant, master.’ Or would that have seemed childish and disrespectful? I wasn’t sure.

‘I’m with the ambulance service. These people called us because they were concerned about you’.

‘What people?’

I asked the little crowd to go back to wherever they came from and thanked them for their help. I could hear no sirens and I didn’t expect to hear any soon. It was a busy night and this man wouldn’t be a priority.

Eventually, I managed to persuade him to stand up and I examined him properly. The light in the street was bad, so I took him to the car and sat him in the back seat. He had a nasty bump to his head, probably caused when he fell to the ground as he staggered about. He had no medical history and complained only of the pain in his head. I advised him to go to hospital and even gave him the option of going in the car to save waiting (it was cold out here) but he refused, while at the same time moaning about his head.

‘Can’t you just check me out and tell me it’s ok?’ he said.

‘Well, I can only see a bump and you don’t know if you were unconscious or not, so I can only advise you to go to hospital’, I told him.

Then he sat in the car and made me stand around like a lemon while he got on his mobile phone to his mate. He spent ten minutes talking to him and describing his ordeal as I stood there in front of him, trying my best to look like I had much better things to do. He ignored my obvious annoyance and continued to chat about his head, the fall, the ‘ambulance bloke’ and what he should do about it. Obviously his friend’s advice was much more relevant than mine.

‘Is that a friend on the phone?’ I asked.


‘Can I speak to him?’


I was hoping to get my point across to a sober person on the phone but the man was rude and there was no way of curing him of it. So I continued to stand in the street waiting for him to make a decision or have one made for him by his buddy on the line. I was getting really annoyed with him now.

After a twenty minute wait, his friend arrived, girlfriend in tow, and asked me what was happening. I explained the situation, including the advice I had given to go to hospital but it was decided that he would go home with them instead. I was glad because I didn’t want to spend another minute with this arrogant guy anyway. I got him to sign my PRF – he was reluctant at first. I honestly think he wanted to have my career as a failsafe should anything go wrong.

‘So if I sign this, you can’t be blamed if I get worse later on?’ He asked.

Mister, you couldn’t get any worse than you are now, I thought.

Sometimes a little threat can produce results when you know you are dealing with a timewaster. I was called to a cell at a police station for a 25 year-old who was ‘unconscious’ on the floor. The police had tried to get him to respond but he was completely out. He had been fine when they arrested him but he suddenly collapsed and hadn’t moved for fifteen minutes now.

The first test I tried was his eyelashes. A gentle brush across them with my finger produced an immediate response. He wasn’t unconscious. He didn’t respond to painful stimulus (a shoulder pinch) so I needed a plan B. I looked at his pupils – they were pin point. He was a known drug user, so I told the police officers (and him) that I would give him some Narcan, just in case he had taken Heroin. I opened my bag but then a mumbling voice sounded in the cell.

‘I haven’t had H, I’ve had MDMA’.

We all looked down at him. His eyes were open and he was, surprise, surprise – conscious.

‘Sorry, what was that? I asked.

'I’ve had MDMA and my head’s f**kin rushing'

The crew arrived at this point and, after a little more coaxing, he came out of his ‘coma’ completely and walked to the ambulance. None of us believed he needed medical attention but we had a duty of care and off he went, moaning all the while about his rushing head. Don’t take drugs then, I thought.

My second false alarm was for an ‘unknown male, lying on ground with feet sticking into road’. I hoped his feet were still attached as I drove to the scene. Of course, when I arrived I couldn’t find his feet. Or his body. He wasn’t there. An ambulance joined me for the area search (just to make sure) and we still couldn’t find him. Someone who is lying in the street with errant feet is more than likely drunk, so it was no surprise to me when I noticed a tall unkempt man staggering around in the bus terminus. I approached him.

‘Were you lying in the street a minute ago?’

He nodded but only because I used my hands to gesture sleeping. He was foreign and made that clear in his first reply to me; ‘No english’.

At least we had found our sleeping feet. He wandered off into the sunrise.

Placenta Praevia is a complication of pregnancy. It’s a common complication I should add but the fact that it presents a potentially problematic delivery is always worth bearing in mind when you go to a ‘birth-imminent’ call. In the early hours of the morning I was sent, with a crew not far behind me, to a 33 year-old pregnant female with a low-lying placenta. She had bled whilst on the loo and her waters had gone. She had no pain and no desire to push but that means little at this stage of pregnancy and it was important to ensure that there was no obstruction to the baby’s passage from the Uterus. She was lying on her bathroom floor but was able to get herself up and out to the ambulance. The crew took her swiftly to hospital where, hopefully, she had a trouble-free delivery. Incidentally, I’d be interested to hear from any women out there who have experienced Praevia.

Just as I was about to pack up for the night, FRED sent me on an errand. I had to go and rescue a 19 year-old who was drunk and who had DIB. Hmmm.

I found her lying on the grass with her friends, outside a club that was chucking out for the night. She had no DIB - of course she didn’t - she was drunk. They were all drunk. She didn’t even want to go to hospital in fact, so I had wasted my time coming to rescue her. I told her friends to take her home and they sheepishly agreed that it would be the right thing to do.

This call had been made by the security guy at the door. I know exactly why he had made it and he should be fined for wasting our time and resources. He had seen her lolling about on the grass with her inebriated mates and wanted her gone from the premises. Part of his job is to ensure that everyone leaves...completely. So he called an ambulance and told us she was drunk. When he was asked by the call-taker if she had problems with her breathing, his answer was easy...YES! He wanted an ambulance to take her away, so of course she had difficulty breathing. This is what we have allowed our service to be reduced to. We are the refuse collectors of society and we are at the beck and call of everyone with a forefinger and a disdain for truth.

Be safe.

Wednesday, 14 November 2007

Keeping it real

Eleven emergency calls – two assisted-only, one treated on scene and eight taken by ambulance.

A 33 year-old who fainted at home was recovering on her sofa when I arrived. I carried out a few obs and the crew took over. She wouldn’t be going to hospital; she didn’t want to anyway.

Another fainting female, this time she was 65 years-old. A doctor was on scene attending to her when I arrived. She had fainted twice, according to witnesses and now seemed to be recovering well and she didn't seem to think a trip to hospital was necessary. The problem, however, was that her age and the fact that she had dropped more than once in quick succession merited further investigation. She was persuaded to go to hospital – it was probably nothing to worry about but better safe than sorry in this case.

A six foot tall drunken 21 year-old man required my attention as he lay in a pool of his own vomit on the platform of a busy tube station. He couldn’t be roused by the staff, so they called 999 and hoped for a swift end to this human obstruction. For some reason the tube staff asked a St. John Ambulance volunteer to help and he appeared at my side as if by magic. I don't mind a bit of assistance so I roped him in and started looking for a response from my dead-to-the-world drunk.

When I shook him hard enough and pinched his shoulder he woke up. He wasn’t pleased but neither was he aggressive – he was one of those smiling drunks who ‘understand the situation’. I managed to get him to sit up but he insisted on falling asleep at every opportunity, so I had to keep him company with a loud conversation until the crew arrived. He had already made it clear that he didn’t want to go to hospital, so we gave him the only choice he had left – leave the station or the police would remove him. He chose the former but we still had to assist him all the way up the escalators; he kept nodding off...even when standing up.

We got him to fresh air and he seemed a bit more alert. He was taken into the ambulance for a set of obs before he went on his merry way. As he approached the ambulance, he noticed the car parked with its lights flashing..

‘Aw, for f**k’s sake – is all that for me?’ he asked.

‘Yep, just for you’, I replied.

‘Aw, go and save someone who really needs it.’

Amen I thought. He was very embarrassed by this, so I think he may just have learned a lesson.

Our hoax caller made no less than six 999 calls tonight. I was sent to one in which he had asked for all three services but specifically wanted the London Fire Brigade to take him to Heathrow! I was still sent to deal with it. Apart from catching him red-handed, I had no idea what else I was supposed to do when I got on scene. Never mind the fact that I was being diverted from genuine calls, I was annoyed that, once again, the LAS had been despatched and not the police...or the LFB.

Immediately after my hike over to the hoax I received a call for a 4 month old baby with DIB. I was now three miles away from this one, all because of this timewasting madman. If the child was seriously ill, precious minutes would be lost and I rushed over there hoping that it was just another ‘hot baby’. Luckily, when I arrived a crew were on scene and they were happy to deal with it.

Back in my own area and a call to a club for a 26 year-old woman who was unconscious after allegedly popping a pill into her drink. Her cousin, who was distraught about this, denied the claim (which had been made by the doorman – apparently he witnessed her putting the pill in her own drink). I didn’t know what to believe and I didn’t really care because the girl was out of it, one way or the other, and my priority was her airway and breathing. The crew arrived and we took her to the ambulance on the trolley bed. She hadn’t responded throughout the entire drama. Her cousin joined her – he still looked shocked and kept apologising for the state of her.

If you are turning 18 soon, go out and enjoy yourself but don’t get so drunk that you can’t remember anything about it. Don’t wake up in hospital with vomit down your clothing and a gang of unknown faces looking at you and asking you questions. This is what happened to my next patient. She ended up unconscious on the floor of the ladies loos, while women were strolling in and out; practically walking over her to get to the cubicles (a bursting bladder negates good manners). It was all very undignified and not the kind of memory your friends should be taking home with them.

When I arrived her mates told me she had been this way once before. She had only turned 18 today, so that means she had drunk so much that she fell down when she was underage. I know parents should allow their kids to experiment and we all had a drink before we were ‘legal’ but getting this drunk in a public place when you are only 17 is not a good reflection on the mum and dad and here she was again...all legal and all unconscious. What a waste.

Outside this club, I notice a little group of teenagers; boys and girls. The boys were taking it in turns to fondle one of the girl’s breasts. I think it was a competition.

A diabetic with a BM of 2.1 was treated on scene with Glucagon and recovered in ten minutes. He was a 27 year-old who really didn’t want any help at first – his condition made him stubborn but not aggressive. His parents were with him and had found him in bed when he should have been at work. His father called us because he wasn’t sure how low his blood sugar level was.

Next, a call from the police for a 20 year-old man who had been assaulted and had a laceration to his head. It was a small wound and the bleeding was easily controlled, so I stuck a small dressing on it and waited for the ambulance to show up. Meanwhile the patient was strangely silent. He wouldn't talk to me; he wouldn't talk to the police. He wasn’t interested. The only reason he was allowing us to treat him at all was because the police were there and they insisted. I really didn’t mind if he wanted to sulk off, quite frankly.

When I greened up from the moody assault I was sent a few streets away to a 74 year-old male ‘collapsed in street, cold and shivering’. I arrived as the ambulance was pulling up and the crew and I went to see the patient together. He was homeless but he wasn’t drunk. He had been found in a doorway by a couple who were passing by. They had noticed how cold he seemed and became concerned about his condition. He certainly looked cold and was shivering violently.

We took him into the ambulance and he winced in pain a few times on the way. He complained about pain in his knee so I had a look at it when he was sitting down in the back. There was no obvious injury and he had no critical medical problems. His temperature was taken - it was 33.3c, so he was going to hospital for hypothermia anyway.

I was just about to leave the ambulance when one of the crew noticed something.

‘Your sleeve has blood on it’, she said, pointing to the right arm of my jacket.

I looked at it and saw a smear of blood. I had no idea where it had come from but it was wet, so it wasn’t from a previous call.

I looked at the old man and checked his hands. I found a deep cut to one of them. He couldn’t remember how he got it but it was likely as a result of falling. The bleeding was under control, so it was dressed and he was taken away to a warmer place.

Combining drugs with alcohol increases your chances of ending up in A&E. I went to an 18 year-old male who was vomiting uncontrollably after a night of cannabis and booze. His friends ‘didn’t know what to do’, so they passed the responsibility (and the cost) over to you, the taxpayer, via me and the NHS. There wasn’t much I could do for him to be honest and I waited for a crew to take him and his sorry mates away to hospital.

I ended this shift with a call that put all the others in perspective. It was for a 57 year-old man with severe chest pain. He has cancer of the liver, kidneys, spleen and spine and is so far down the line that his own morphine doesn’t ease the pain any more. His wife apologised for calling us out. He had been suffering for four hours before deciding to get an ambulance because he (and she) didn’t want to inconvenience us! I told him that he was precisely the reason we existed and that he should never allow himself to suffer for so long before calling us.

He was taken to hospital where, hopefully, they relieved his pain. I know the man is in his end days though. It’s frustrating to know that there are people like him out there, biting their lips and suffering instead of calling 999 while all around them the freeloaders and timewasters of society a racking up billions of pounds in wasted taxes to feed their addiction – the belief that a free service is available on tap just for them when they get a headache or fall down drunk.

Be safe.

Tuesday, 13 November 2007

Death's door

Six emergency calls – one refused and five required our attention.

Again, a relatively quiet night; the cold weather is probably responsible for the lack of people willing to go out and hurt themselves. The air is beginning to get a little ‘nippy’, as we say in the Homeland and the first frost is developing in the mornings when I come home from work. Of course, that means winter is here and the giant commercial beast that is Christmas is just around the shopping corner.

It all starts with a 55 year-old man who has ‘collapsed’ outside a pub in the City. Now, I know you will think I am a cynic but when I see the words ‘collapsed’ and ‘outside pub’ in the same sentence I usually expect to arrive at the scene to find a drunken male/female/shemale slumped against a puke-covered brick wall, surrounded by clucking friends who firmly believe that he/she/it has been ‘spiked’ or has ‘never been like this after just the one drink before’. Such is the inevitability of our descent into predicting calls of this nature – it creates singularly critical individuals of us all eventually.

I was wrong, however, but luckily I am armed with caution when I make presumptions – too many calls in the past have been genuine and I am always wary of making too quick a judgment.

I arrived to find a man standing at the door of a little pub. He looked unwell and two of his friends were on hand to help him. He was very pale and sweaty. He had suddenly felt unwell and looked like he was going to collapse, one of his mates told me, so they walked him outside and called an ambulance, such was their concern.

‘I had food poisoning over the weekend’, he told me.

That put it into perspective. He had no chest pain and he had no medical problems apart from a little hypertension and type two diabetes. I checked him for changes with either his blood glucose or blood pressure and found nothing untoward. I guess his food poisoning problems weren’t quite over.

A crew arrived within a few minutes and he was taken on board the good ship LAS for further checks (including an ECG).

I went on my merry way and found myself heading back to my own area for a 48 year-old female ‘fall, hit head, DIB’. Unless a head injury is significant, DIB is rarely a factor worth considering in these calls and it is a real problem for us because that single term determines the category of the job. It becomes much more urgent if those letters are added. I expected to find someone with a bump to their head and absolutely no problem breathing whatsoever and that’s exactly what I got when I arrived on scene.

The lady had slipped at work and cracked her head on the concrete floor. She had a nasty bump, a sore wrist and a painful rib. The rib injury was causing her to breathe cautiously, due to the pain but it didn’t impede her breathing and wasn’t in any way life threatening. Nevertheless, even though an injury like that should go by taxi to the nearest A&E, she was taken by ambulance to hospital.

Now that the weather is becoming colder, we tend to experience an increase in calls from the homeless as they attempt to secure warm lodgings and perhaps food in one of the local A&E departments, so I wasn’t at all surprised when I was dragged off to E1 for a 64 year-old man who claimed he had suffered three fits and was about to have another. He had managed to explain his medical emergency himself, lucidly and calmly, from payphone. When I arrived a crew were on scene and he was in the back of the ambulance chatting to them about his woes. Sometimes it’s hard to elicit sympathy from a crew who can feel the wool being pulled and so he wasn’t receiving the warmest of receptions but I guess we all have to put ourselves in their place. What would you do if you had nowhere to go on a bitterly cold night? Dialling 999 is still free (until the commercial animals get a hold of it) and generally speaking, the ambulance service aren’t going to say no to you.

I went south of the river for a 55 year-old lady who had collapsed on a tube train. I think she had mental health issues because she behaved erratically and refused to speak with any clarity or explain herself properly. Witnesses told us she was slumped in her chair and wouldn’t rouse when a member of staff attempted to wake her. The train had passengers on board and I don’t think any of them appreciated this delay in their journey as the crew and I attempted to get sense out of her. Some of them left to find other means of getting home. I was also wary of the fact that the entire line would be slowed or stopped as a result of this woman’s behaviour.

In the end, with exhaustion setting in on both sides, she stood up, refused any help and walked off the train. She crossed the floor to the other platform and stood there, petulantly, waiting for another train (going in the opposite direction). We had no choice but to leave her to it and the staff apologised to us for wasting our time.

After a good few hours of nothing, I went with a crew from my station to a 24 year-old who had fallen and sustained a head injury outside a gay club in the West End. It was freezing and rain had just fallen, so it was wet and freezing.

The man had fallen onto the ground and split his head open above the eye. In itself, the injury was innocuous but as he was too drunk to realise what he had done, it was safer to take him to hospital than it was to let him go home, which is what he wanted to do. Luckily his boyfriend persuaded him to take the sensible option. At this time in the morning and under these weather conditions options like this don’t hang around. I think he fancied one of the crew too.

My last call delayed me getting home but I didn’t mind because this patient needed us. It also reinforced my annoyance with people who insist on using the term DIB when they have nothing of the sort because this patient really was in trouble. He was a 48 year-old lung cancer patient who had developed severe DIB during the early hours and it had got worse as time went by. His frantic wife called us out because she had run out of options.

When you walk into the room of a person who is at death’s door, you know it immediately. There are no ifs or buts, a time-critical patient is an obvious sight. This man was at that door. His breathing was desperate, his eyes were pleading and he was using every muscle in his body to gather the strength to pull air in. If I could round up every caller who allowed the term DIB to be associated with their petty problems I’d shove them into this room, tell them to look at my patient and say ‘THAT is DIB’.

As soon as the crew arrived we took him to the ambulance. His lungs were filling with fluid, so I tried every drug at my disposal to resolve his immediate problem. His sats were in the low 60’s when I first checked them and even now, in the back of the ambulance, with a 100% oxygen mask on, GTN and Frusemide in his system, he wasn’t improving above 85%. He was diaphoretic, weak and scared. Every time I leaned over him I could smell that acrid, sticky aroma that hangs around the terminally ill; the smell of death. You can’t detect it during a resus and you don’t pick it up with acute emergencies – it’s associated mainly with long-suffering tissues and the ongoing breakdown of living stuff. I wasn’t fooling myself. I wasn’t going to save this man’s life. I was going to buy him enough time to say goodbye to his wife. I knew that, my colleagues knew that and he knew that. All I could do was try to make him comfortable, which in itself is an insult to the actual reality of the situation.

We got him to hospital in a reasonably stable condition and I handed him over to the doctor in Resus. His wife sat in the ‘family waiting room’ for news but her face was etched with despair and a fixed gaze developed in her eyes. I told her not to worry and that he was being taken care of now and she acknowledged everything I said without hearing a single word of it.

Be safe.

Monday, 12 November 2007

Where have all the patients gone?

Two calls – Yep, two (2)! Both went by ambulance. I've recently started another six month secondment on the FRU and the new rota includes a nasty four night run over the weekend every five weeks. I wasn't looking forward to this first one but tonight surprised me. The usual drunken fools gave way to decent law-abiding veterans and their loved ones who had been out all day for Remembrance Sunday and now they were spending the night in London; drinking sensibly, going to the theatre and eating out. This produced one of the quietest nights I've known for years and it reflected what used to be the case on every night shift for the ambulance service years ago when the world wasn’t out to get as drunk as possible.

I don’t know if all of my colleagues had such a quiet one but there seemed to be more crews sticking around stations (I work between two) than usual. I’m not expecting to experience a night like this again for some time, if ever, but I was glad of the slow-down in pace. I felt a lot more relaxed when I went home.

So, my shortest posting of a shift ever begins with a 52 year-old man who was described as ‘not alert’. The police were on scene because the call came from the City and they are very good at responding to medical emergencies out there (they are specially trained and carry defibs). Unfortunately, when I arrived they had gone into the hotel mentioned on the address when the patient was actually outside in a black cab. This fact was made known to me by the cab driver, who, obviously confused, had not alerted the police when they arrived but had waited a few seconds until I got there and came to get me. The police followed when they saw I wasn’t going into the building.

The man in the back of the cab was collapsed on the floor and he was deathly pale. Sweating profusely, he could barely speak but his colleague told me what had happened. He had a history of kidney cancer and was on a cocktail of drugs. He had suddenly collapsed after making one of the most ominous (and often last) statements we hear second-hand; ‘I’m not feeling too good’. He then passed out onto the floor and remained unconscious for a few minutes.

I gave the man some oxygen, the universal waker-upper, and he began to recover slowly. He became more lucid and explained that this had happened to him twice before and the doctors could find no cause for it. It didn’t help that he was fully recovered by the time he arrived at hospital, so there was very little for doctors to go on. I suggested he should go back to hospital and try again and he agreed. He was a visitor from up North, so letting him get on with his evening would have been a mistake, I think.

When the crew arrived to take him away, he had completely recovered, just like he said he would. To be honest, I think his one remaining kidney (he had one removed because of a tumour) is being affected by the cancer he has and its function is becoming impaired. One of these functions is the regulation of blood pressure. But then, what do I know?

A few hours into the shift and I was sent to a lovely little ‘Christmassy’ crescent near King’s Cross. It was one of those streets that look as if it was designed by the Disney Corporation for one of their ‘this is how olde London looks’ films. Charming. Unfortunately, these handsome townhouses are now broken up into flats, one of which housed my patient. He had been smoking cannabis and was now suffering from chest pain.

When I got on scene, I was directed to him by his slightly embarrassed girlfriend. The man, a 30 year-old, had right-side chest pain which, as he described it to me, sounded pleuritic, not cardiac. We never rule heart problems out, however, so he was given the works, including an ECG to determine the possible cause of his discomfort. He had a few anomalies on the 12-lead but nothing that screamed imminent cardiac arrest, so he was taken to hospital for further investigation. Obviously, drugs can irritate the body systems and its possible he has just abused himself and was now being penalised.

Speaking of Christmas (is it still legal to say that word?) I can't believe the Oxford Street lights are up and ON already! Give us a break. It's barely gone Hallowe'en. How desperate are we to shove consumer tat down everyone's throats. No wonder the 'real' religions think we are hopeless. Leave it 'til December please!

Then I sat on stand-by for a while and watched the old men and women and the not so old men and women (and related children) go about their peaceful business in the West End. I saw no drunks, no fighting, no stupidity and no vomit on the pavement. All I saw were poppy-wearing heroes with chest fulls of medals. Maybe the youth of our Capital went home early because they couldn’t compete with men and women like these. Maybe they were intimidated by the presence of so many good people.

Whatever it was, I thank you all for allowing me and, I hope, many of my colleagues a bit of a break from the usual stress. For once in a long time I am able to sign off a posting with the same phrase I have used many times on calls. Not required.

Be safe.

Sunday, 11 November 2007

Luck and fate

Seven calls; one assisted-only, one running call and the others needed an ambulance.

A chunk of concrete (it looks like a missing tooth) came away from the roof of the Selfridge building in Oxford Street. It fell over a hundred feet before exploding on the pavement, inches from a 17 year-old girl who was walking underneath at the time. This happened in daylight, when shoppers were out and about and it was only by sheer luck that she didn’t get seriously hurt. In fact, she escaped without a scratch.

This has happened before; last year a man was killed outright when one of these blocks came away and landed on him. Fate seems to have saved the lives of this girl (and many others if this had happened on a busy Saturday).

I got this call as a ‘please investigate’ after someone dialled 999 and said that a friend had called from Oxford Street to say that someone had been hit by a car. Control thought it might be a hoax, so sent me to check it out. I sped down there to find the police around the area, cordoning the pavement off and tending to this emotional wreck of a girl. Her friends were with her when it happened and they all looked a little shocked.

The police told me that they had received a call saying a bomb had gone off. Now it all made sense – the sound of that large brick shattering after its long and very fast journey to Earth must have been so loud that people in the distance had mistaken it for an explosion or the sound of a car hitting someone at speed – thus the calls.

I handed her over to the crew when they arrived and took this picture because I think something needs to be done about this urgently. Apparently work was carried out to check the integrity of these slabs after the man was killed but this has obviously failed to make things safe for people walking below, so maybe they should consider the design of this area of the roof. Maybe they should all be removed and replaced with something less hazardous or secured in some other, more permanent way.

I had started my shift with a call to a 50 year-old man who collided with a van whilst riding his motorcycle. The force of the impact ripped the number plate from the van and his ride was totalled. He was lucky enough to escape with a fairly minor leg injury and the only real hazard was the lake of petrol that was on the pavement. The LFB soon arrived to clear that up, however.

Then a 52 year-old woman with DIB but there was already a MRU and ambulance crew on scene, so I was not required and bowed out gracefully.

I witnesses an ugly little scene on my way back to the station. Again, in Oxford Street. A woman (a tourist in her 60’s I think) was crossing the street and didn’t notice a cyclist coming towards her as she walked into the road. I heard the cyclist shout something at her and then plough into her, knocking her down. She fell quite hard and the cyclist (and bike) tumbled after, entangling them in the road. I was going to see if I could help but they both struggled up. The cyclist had been underneath the woman, so he pushed her, quite aggressively, so that she rolled away from him. It was a very undignified thing to see. The poor woman stood up, dusted herself off and then was treated to a volley of verbal abuse from Mr Cycle man. Totally unnecessary in my book. I thought cyclists were calmer people because they got out more. Obviously I’m wrong.

A call to a 37 year-old with palpitations was a non-starter because, once again, the crew were ahead of me and I would have been a spare part.

Childbirth is a natural thing, we all know that but a first time mother with no family support needs reassurance. A 27 year-old, pregnant with her first child, single and without a family network, called the ambulance service because she felt faint and dizzy. She told me she had tried to get in touch with her midwife but couldn’t get an answer. In desperation she dialled 999. She was genuinely apologetic about it but didn’t know what else to do because she didn’t understand that the way she was feeling is part of the normal process of pregnancy for mothers. I helped her understand that everything was normal (all her vital signs were good) and the crew arrived to reinforce that. She went home much happier.

If you vomit once, it’s probably nothing. If you vomit twice then it’s probably worth resting and getting over what might be a stomach bug or food poisoning. If you vomit almost continuously for three hours, I suggest you have waited far too long to get it checked out.

A 40 year-old man was claiming this when he called us to a train station after slumping in a corner and telling staff he had been throwing up all over the place. I couldn’t understand why, if he was already out and about, he would wait so long and not take himself off to A&E. He waited three hours before doing anything about it, then decided an ambulance would be the right choice. Oh and he admitted eating lobster earlier in the day.

While I was at the station, doing my paperwork after the vomiting man, I was asked to take a look at a PCSO’s hand. He had been bitten by a drunkard as he tried to move him on.

He came out and showed me the injury; it was small and nasty and would certainly need to be cleaned but it also represented a potentially serious health risk to him. If the guy who had done this had HepB, Hiv or any other nasties, the cop could contract an infection through the wound. I arranged to take him to hospital myself while cops arrived by the van load to take care of the culprit.

I went into the station and spoke to the vagrant who was now lying, pinned down by the police, on the station concourse.

‘Do you have any medical issues. Any infections or diseases?’ I asked.

‘Yes’, he spat.


‘F**K off, I’m not telling you!’

Then he started kicking the police officers who were restraining him. I know one of these officers well – she is a friend of mine from Waterloo Train Station, where she is based. She is a big, strong woman and kicking her in the stomach, which is what our violent vagrant did, is a bad idea. She launched herself on top of him and he was flattened to the floor. He could breathe but he wasn’t going anywhere or kicking anyone again.

I took the PCSO to hospital and he waited to get checked out. He’ll probably need to give a sample of blood and the vagrant may have his taken so that any risk can be assessed and dealt with. Strangely, they call those who bite or inject us with their bodily fluids 'donors'.

After all that excitement, I got to go home...on time.
Be safe.

Friday, 9 November 2007

The weeble guard

Twelve calls today – two refused, on false alarm, one assist-only, two conveyed and the rest went by ambulance.

I scoot between Waterloo and the West End via Whitehall in the early mornings and this gives me an opportunity to flick a wave at the guard standing at the entrance to Horseguard’s. They start their shift early, just like me, but for the life of me I can’t work out what they are guarding against at that time in the morning. Anyway, one of them has been sneaking a nod in my direction when he sees me and it’s nice to be able to communicate, even if that’s as much of a conversation as we can achieve.

This morning, my friend was nowhere to be seen and another young lad was standing at the gate. Well, he was mostly wobbling at the gate. He must have been out the night before because he looked in imminent danger of falling flat on his face. He kept startling himself into a rigid posture, only to relax again and drift towards weeble-land and an inevitable drop. I had the opportunity to watch him for a minute or so as I waited at the traffic lights but I continued my journey and didn’t see what became of him. I don’t know what the drill is if one of these guys falls. Do they get disciplined?

We weren’t called for him so I’m guessing he sorted himself out in the end. Just as well because the horses come on duty later in the morning and they wouldn’t have approved.

My morning started off with a call to a 38 year-old male, ‘vomiting blood’. He claimed to have lost about two and half litres of the stuff and I was more than a little wary of his estimate. He was HIV positive and he told me he had never had trouble like this with his health before. It looked like trouble was catching up with him. His bathroom was spattered in blood and he had a recent history of passing tarry stools. Ominous though the signs were, he remained fully alert and was able to walk himself out to the ambulance when it arrived (he had initially walked out to greet me when I got on scene but I took him back into the house).

Then a 34 year-old pregnant woman who fell down stairs at a railway station, injuring her ankle. I had to reassure her that her baby was fine and that her ankle was a long way off her womb. When the crew arrived, the kind rail staff provided us with one of their electric buggies to convey her to the ambulance in. I hitched a free ride and watched my colleagues walk back. Well, I did offer.

I was cancelled on scene for my next call, to a 40 year-old male with lung cancer who was coughing up blood. A crew were already there and I would have been excess baggage.

A strange call to a 30 year-old woman after that. She worked in a posh(ish) hotel near Trafalgar Square and collapsed with a numb arm whilst going about her duties (cleaning rooms). She had no history of illness and hadn’t taken anything (drink or drugs) recently. A Motorcycle Response Unit (MRU) colleague was on scene when I arrived and we cancelled the ambulance; I would take her to hospital in the car because she didn’t seem to have any significant medical problems – just this numb arm.

When I got her to hospital, the nurse noticed that the affected arm was also slightly swollen. I hadn’t seen this to be honest and I don’t think the MRU medic had either. The swelling wasn’t massively obvious but when it was pointed out, it became noticeable.

I went back to check on her later in the day and was told that she had been diagnosed with Carpal Tunnel Syndrome.

I wasn’t required for the next call. The crew had already arrived and were dealing with a 20 year-old female who felt ‘dizzy and sick’ but I was required for the call after this one – a 19 year-old female who bumped her head and was emotional. I conveyed her myself because she really didn’t need an ambulance. She travelled with her friend and work colleague and as we chatted I got to know how fragile she was.

She had fallen after going to the loo and bumped her head on the tiled floor of her workplace (a dental hospital). She had no serious injuries; not even a bump on her head, but she was shaken up and a bit teary-eyed. She insisted on being taken to hospital and I sensed that she probably needed the reassurance.

I discovered during the trip that she didn’t drink, smoke or have any tattoos on her body (although quite how that detail got into the conversation I can’t recall). I found this unusual. It’s rare these days to find a female without a vice, or who hasn’t marked themselves. Maybe she was a nun, I thought. Still, she was a pleasant young lady and she was delivered to hospital in a much better frame of mind than when I first saw her.

Later in the shift, I was sent up into the north (of London) for a call to an 80 year-old man who had fallen out of bed. I found him slumped on the floor with a couple of nasty looking cuts to his head. He had fallen hard and it looked like this wasn’t the first time. His carers were on scene as well as a neighbour who had known him for decades. The neighbour was more concerned about his condition than the carers, I have to say.

The man had suffered a stroke before and was now unable to communicate properly. He’d shout ‘No!’ every now and again but that was the extent of it. He was also quite unable to fend for himself and couldn’t get off the floor without assistance, so I propped him up a little and tried to get to the bottom of what had happened.

Apparently, he had pressed a button on the control panel of his specialised bed which lowered a guard rail at the side. Then he had simply fallen over the edge when he got too close, landing heavily on the wooden floor.

‘Why is the button so near him?’ I asked the carers.

They both shrugged their shoulders. I rarely get any clear information from home carers and I have no idea why.

‘Don’t you think it’s unsafe for him to have any access to this panel?’ I suggested.

Again, blank looks. I wondered if they spoke English at all.

We had no idea how long he had been on the floor. He could have lain there all night. His neighbour was not impressed by the level of care he was receiving and when I asked for his diary ( a document which records the day-to-day activities of the carers) nobody seemed to know what I was talking about. It was produced eventually, when the penny dropped.

The crew arrived and he was carefully lifted onto a chair and then out to the ambulance. His head injuries needed attention and as I walked back to the car I wondered how long it would be before we were called again to the same address.

Even during daylight hours, calls to sleeping drunks can be generated by frantic members of the general public. A call for a 30 year-old female who ‘cannot be woken’ on a park bench had me racing a long way out of my area to find a woman slumped across the seat, which was out on the pavement at the park entrance. I walked up to her, shook her twice and woke her up.

‘Do you need an ambulance?’ I shouted.

‘Oi! F**k off!’ she replied.

Did I tell you I have a degree in waking drunks up? I walked back to the car and completed my paperwork. Then I made my way back to my own patch and my own drunks.

A 52 year-old woman with a history of internal bleeding (although we were never told why) called us for chest pain. When I got there I realised she was very depressed. She still complained of chest pain but she had a lost look about her and the crew got very little out of her when they arrived to take her away. She made me feel a little depressed in fact.

My next call was for a 21 year-old female with abdominal pain. She was writhing on the floor in agony when I arrived. She had a history of ovarian cyst and it looked to me as if she was suffering at the hands of an old enemy. The ambulance didn’t take long to arrive and she was quickly taken away. Pain relief was given but nothing seemed to be touching it. I felt sorry for her.

As the evening drew in I was called to a RTC in Camden where a moped had collided with a brand new Porche. Neither the moped rider nor the car driver were hurt but that expensive set of wheels (the Porche obviously) was badly damaged. Not because the moped had struck it but because the rider, a heavily built man, had been thrown onto the boonet before sliding off onto the road. His journey had left a major dent in the car as well as a long, deep scratch in the paint work.

With twenty minutes of my shift to go, Control sends me to a 25 year-old female who is unconscious in a tanning shop. The police were on scene for some reason and the staff were more than a little concerned about the woman's behaviour. She was conscious but looked stoned. She definitely looked as though she had taken something.

'Have you taken any drugs or medicines today?' I asked politely.

'No. I'm fine. Leave me alone', she said.

She was wobbly, disorientated and had slurred speech. I was concerned about her condition and she was adamantly refusing to go to hospital. Neither the police or myself could persuade her and her temper was beginning to fray but it spilled over when the maager of the salon explained to her that, because she had refused treatment, she could not be allowed to use the tanning machines again until an 'all-clear' had been given by a doctor.

I thought that was fair enough but the woman went ballistic and had to be told to calm down or else by the police.

After a twenty minute argument, she stormed out of the shop and I was left holding my bags in the air like a lemon.

I ended my shift by wandering back to my base station via Whitehall. I glanced across at the parade ground entrance. The guards were there but the horses were gone (they get taken away when the light fails) and the tourists were going back to their hotels. London was winding down and so was I. Time to go home.

Be safe.