Friday 2 November 2007

Dancing queen

Seven emergency calls – one assisted-only, one refused, one arrested and four taken by ambulance.

A 45 year-old homeless man who woke up in the street, covered in bruises and suffering chest pains called us out because he didn’t know how his injuries happened. It was a mystery to me and the crew too – his chest area looked as if someone had stamped all over it. He also had bruises to his legs and arms; he had clearly taken a beating at some point and I couldn’t believe he just slept through it.

‘How did you get these bruises?’ I asked him.

‘I don’t know. I can’t remember’. He replied.

Either he was knocked unconscious in the first few seconds of the assault or he just wasn’t prepared to tell anyone. The police were on scene too but they got nowhere fast. I understood this, however. Life on the street is rough and he was probably trying to protect himself from a worse beating in the future if he pointed the finger. Street people have their own territories, rules and unspoken agreements.

Although he was in a lot of pain, I couldn’t give him morphine because he had liver disease. He was given entonox instead but it didn’t seem to take the edge off it for him, so the crew got him to hospital quickly. He was conscious throughout and was able to walk but there was no way we could ignore the possibility of unseen injuries, so he was collared and put on a board for the trip.

The police, a motorbike responder (MRU) and myself were all called to a ‘20 year-old male, unconscious on a bus’. A hundred per cent of these calls, in my experience, have turned out to be nothing more than a sleeping drunk. In most cases, the bus driver is either too scared or simply not prepared to try and wake them up. It is bus company policy to dial 999 and get us on scene and I'm sure a few people will argue that the person may have a serious medical problem and I can’t dispute that but, statistically, the only real problem they have is alcohol.

I can go and investigate a call like this myself but when a little river of blue lights show up for one stubborn drunk it becomes a charade and I wonder what people think of us. The MRU paramedic sat on his bike shaking his head in disbelief – this is over-resourcing and will one day cost a genuinely ill or injured person dearly. Despite the flak I get for pointing this stuff out, I would remind everyone that WE pay for this and that it is time for common sense to be brought back in to the equation. Remove the decision-making computers and start taking responsibility for decisions in a human world. Rant over.

I walked onto the bus, shook the man a few times and he swung at me with his fist. That was my signal to let the police drag him onto the street, which they duly did. He was shoved into a corner and given a lecture about being abusive. We all left the scene and a major incident was averted. Twenty minutes, four professionals and a couple of hundred quid. He will do it again and again for years to come. It would be cheaper to buy this man as much alcohol as he wanted and give him his own personal bus to sleep on.

I know I have had my go at cyclists in London and I still feel angry at the way some of them behave – running red lights with impunity, speeding across pedestrian crossings when people are on them, being rude to drivers who let them know how annoying they are - but sometimes I get called to a cyclist who has suffered at the hands of a motorist, like the 35 year-old man who was knocked off his bicycle on a busy road by a driver who wasn’t looking or didn’t care to see him. The car swerved in front of him, clipping his wheel and throwing him over the handle bars.

When I got on scene the police were already dealing with the driver, a middle-aged woman dressed in a smart suit. She looked badly shaken up by the experience and didn’t know where to look when one of the police officers produced a breathalyser. I think her world had just come crashing in.

The cyclist had gotten away with a fractured collar bone and dislocated shoulder. I noticed a long scar as I treated him.

‘Is this scar from an operation in the past?’ I enquired.

‘Yes’, he replied, ‘I've broken this collar bone before and had to have it operated on’.

‘How did that happen?’

‘I was knocked off my bike by a car’.

The man hadn’t been wearing a helmet and this was not his first encounter with other vehicles on the road. I was beginning to wonder if he had any common sense.

The crew arrived shortly after I put him in a sling and he was taken to hospital.

I went back to Leicester Square after that job and had a few minutes to myself until a call came through for an 80 year-old man who had collapsed at one of the casinos in the area. I didn’t need to drive, so I grabbed my stuff and walked across the gardens to the address. The location I was given was inaccurate, however, and I found myself on a building site. The builders inside became concerned when I told them a call had been made from their location and, thinking that there was only one place in the building where anyone in trouble could be, they took me to the cellar area where a locked door barred us from getting any further. I thought we might be breaking this down to get to a dying man underneath.

That drama didn’t happen – one of the builders pointed out that there was another casino next door which shared the building’s address, so I made my way there and asked the girl at the reception desk if they had called an ambulance. She didn’t know but one of the security guys did and he led me downstairs to the patient.

Among the little crowd of gamblers in the lounge bar, a pale and sweaty Chinese man sat. He was known to the casino staff but had no friends with him. He had collapsed and fallen onto the floor whilst playing roulette. As I assessed him and translated my concerns through an interpreter (getting Chinese interpreted in this part of London is easy – China Town is behind the Square), I discovered that this had happened before but he didn’t want to go to hospital. He seemed to be recovering and was clearly only interested in continuing his day’s fun and games, so I waited with him for ten minutes, carried out more obs and asked him a few more times if he was sure. He was adamant. He signed my form and I left him in peace. The casino manager said he would keep an eye on him and I walked out wondering how much money the Chinese man loses every day.

On a shift where it seemed every patient was going to be male, I headed to an address to deal with a 63 year-old man with chest pain and SOB. He had a history of MI and was currently on GTN and aspirin – a standard combination for cardiac histories. He had taken his GTN and this had brought some relief from the chest pain he had originally called about. It’s useful to us to establish what a person was doing just prior to the onset of chest pain as this can help to eliminate a possible MI from simple angina. This patient had not been exerting himself when the pain started, so it was best if he went to hospital, especially as he had experienced some shortness of breath during the episode. The crew arrived as I completed my obs and I put a precautionary cannula in just before we set off for hospital. He arrived in a stable condition with diminishing pain and no SOB.

Another expensive call – this time involving a cycle responder (CRU), the police, an ambulance and myself – for a 20 year-old male who was ‘fitting’ in a large department store in Oxford Street. The descriptor included the words ‘been caught shoplifting’ and I knew I was heading to a faker.

Sure enough, when I got on scene, I joined the police officer and my CRU colleague to witness the worst parody of epilepsy I have ever seen. The young man was flopping around on the floor, clearly conscious, with a co-ordination that can only be brought about by an alert and fully functional brain. He was asked repeatedly to stop the charade but refused to play ball for twenty minutes until he grew so tired of it himself, he simply gave up and lay on the floor staring up at one of the funniest cops I have worked with. The officer had no sympathy for the boy on the floor (it transpired he was only 15 years old) and verbally berated him until he behaved himself and sat up to be questioned. His stony face and no-nonsense attitude was just what was required for this delinquent and it was refreshing to see that it still existed. None of this ‘yes sir, no sir’ rubbish that the police are forced into – he was an old school cop and was having none of this lad’s stupidity. It struck me that the policeman’s approach was probably good for this young thief – he probably needed a father-figure, if only for a few hours.

The ambulance crew arrived soon after the boy began to ‘recover’ and we all waited on scene just in case he decided to do anything stupid but he behaved and began to talk to the police, who were now three-strong and included a very attractive WPC...not that I was looking.

At first the boy lied to the officers about his details, then he told them everything they wanted to know but he included a detail that they hadn’t asked for; the name of an accomplice who was waiting for him across the street! They had been on a shoplifting spree, stealing mainly clothes from shops up and down Oxford Street. Now his mate was standing outside one of these stores waiting to meet up. Little did he know the police were on their way to arrest him, thanks to his loyal friend. I think the lad was bitter about being caught. Maybe he should consider an honest life.

The only female patient of the shift was a 27 year-old woman who fell during a dance class and twisted her ankle. She was lying on the floor at the back of the room as dancers continued their lesson around her. She had a badly sprained ankle and was in a lot of pain. I gave her entonox for that.

The crew didn’t arrive for fifteen minutes, so I had plenty of time to assess her and discover what had happened. She was quite a big girl and I looked around the class wondering how she fitted in – all the other dancers were slim, light and looked like ballet professionals. I didn’t want to be rude but I had to ask.

‘So, you were dancing with this group when you twisted your ankle?’

‘No, I jumped up and fell awkwardly on it’.

I had been there long enough to notice that none of these dancers were jumping around. They were doing stretching exercises.

‘Why were you jumping up?’

‘We were jiving’.

‘Jiving? What, this lot?’

‘No. This is the other class. My class left half an hour ago’.

So, she had been with a jive class and fallen badly. They had left when the class ended and the next dance class had come in while she was lying in agony on the floor with nothing but a few ice packs and a member of staff for company. It seemed comically ironic and the cruellest part of my humour smiled at the thought. The poor girl had been on this floor for almost an hour waiting for an ambulance. She probably had to wait because we were busy with an ‘emergency’ shoplifter.

When the crew took her away, I had one last look at the graceful things dancing in front of me. I don’t see much beauty in this job, so my last few minutes on duty were spent in this pleasant world. I think I can be forgiven for the indulgence.

Be safe.

4 comments:

Anonymous said...

Hi,

I would just like to comment about your interesting take on the cyclist. I am afraid this may generate a lot of rabid comment from both sides, but I am interested from the medical point of view about the use of cycle helmets. There are many arguments against the use of cycle helmets in the urban cycling context. I am not going to reproduce them here, as a quick Google search wil bring up hundreds of websites debating this very issue. However, I wondered what the medical take on this was, so I would appreciate some discussion abut this, and thought that since you have mentioned it I may as well ask tentatively?

Also, if I may be slightly cheeky, I could also point out that the use of a cycle helmet would have done nothing to prevent the injuries in this particular case...

Thanks in advance

Mel

Xf said...

Mel

Quite right, the helmet wouldn't have prevented these injuries but my point was that he had a history of being knocked off his bike by cars. Sooner or later his head will meet the ground first.

My opinion, from a medical point of view, is that you should always protect your head if possible. It guarantees nothing, I know, especially for cyclists, but it may mean the diffrence between life and death.

Anonymous said...

I'm a twenty-something and have been found unconscious on a London bus without the involvement of alcohol - I was in an Addisonian crisis combined with hypoglycaemia.

With multiple chronic medical problems, I know I'm the kind of person who is at risk of paying a personal price for all the idiots who can't stop themselves getting paralytic. What worries me is that this is not just a risk because of ambulances or paramedics being unavailable to treat me at a time when I may really need them but because some staff are becoming so jaded by what they see.

A number of years back an ambulance was called to my house. The crew spotted a half drunk bottle of wine on the table and insisted to my flatmate that I was just drunk and should sleep it off at home. They seemed so convinced that a young person could only be ill through drinking alcohol or taking drugs that they wouldn't listen to my flatmate telling them I had had no alcohol all day. They only took me to hospital at her insistence and with no urgency. It was only when I made it to hospital that the urgency kicked in. I had encephalitis and my brain was crushing itself against the inside of my skull. I came very close to death.

People who drink too much, or call ambulances inappropriately, risk other people's lives by the effect they have on attitudes, not just the effect they have on resources.

Xf said...

anon

You are absolutely right and please don't think I judge every bus-borne patient as drunk. I generally give it a go with them before I make up my mind.

You have a particular problem and you can't predict where or when it will strike. The huge number of calls we receive that involve alcohol or stupidity (or both) make us wary of believing genuinely ill patients sometimes and for that I apologise. You and others are definitely put at risk by the abuse of the system.