Wednesday, 30 January 2008

No patient contact

Seven calls – one hoax , one no-trace, one taken by police to hospital and four by ambulance.

A reasonably calm start for my first day back I think, although I was quickly reminded of frontline reality when the first call, for a 16 year-old female who was being assaulted by a collapsed male in the street turned out to be a hoax, resulting in me, an ambulance and a police car scooting around the King’s Cross area vainly looking for a job to do. A motorcycle paramedic had been dispatched too, for good measure, but his time was being wasted too and he didn’t stay on scene long.

Later on, a 26 year-old patient with a heart condition (which is rarely specified and so could be anything from an infection to a dodgy valve) required an ambulance because he was experiencing pains up and down his back. This, incidentally, was accompanied by DIB but I rather doubted the connection, although I wouldn’t stake my career on it – these things are always worth checking out. Unfortunately, a crew arrived directly behind me as I got out of the car and I became excess to requirements.

I was whiling away the time on stand-by when a call came in for a 35 year-old man who was ‘standing in the middle of the road, covered in blood’. Now, this will usually get someone’s attention. Not only that but he chose to carry out his stunt in front of a hospital. I think I’ve explained before that an ambulance will usually be called for you, even if you have collapsed on the doorstep of the hospital because the staff are not insured to treat you in the street. So, you can forget most of what you see on Casualty. They won’t be running out to get you. They will probably watch you from the windows until an ambulance arrives and takes you the couple of metres inside the hospital premises.

When I got on scene, the patient was nowhere to be found. I called it in as a possible hoax but a concerned looking man approached me.

‘Are you looking for the bloke who was in the middle of the road?’ he asked.

‘Yes.’ I replied.

‘He was there but he’s gone now. He was covered in blood and he just stood in the road chucking things at the passing cars.’

The hospital ambulance bays were full, so I figured a crew might have seen him and taken him inside. Either that or he had wandered off to an even busier road. I decided to check with the hospital staff first.

Sure enough, as I went into the Majors department, security men were standing over a blood-spattered man with wild, ‘mental-health-issues’ eyes. I confiasked one of my colleagues if this was the object-throwing maniac from earlier and he confirmed that it was. The police had found him and brought him here. I watched as a cleaner mopped up the drops of blood he had brought in with him.

So far I hadn’t actually made any clinical contact with a patient and the day was ebbing away. I’m not complaining but I get bored if I’m not doing something useful. Luckily, my next patient broke the pattern. She was a 26 year-old Polish woman who, according to witnesses, had been hit by a speeding cyclist who was travelling along the wrong side of the road. He collided with her as she tried to cross over. She went flying and sustained a lower back injury. A private ambulance crew had stopped to render aid, so I got a bit of a handover from them.

A taxi driver witnessed the incident and was happy to give his name and address (I don’t think he liked the cyclist) so I went to talk to the alleged assailant. He was a tall, gangly man and he lied I think. Not only hadid he tell me he was going at a snail’s pace when he hit the woman but he became indignant and pedalled off when I suggested he wait for the police to get the story sorted out.

The crew took her to hospital and the police were asked to meet her there. The cyclist will probably never be caught.

An Motorcycle paramedic was already on scene and dealing with my next patient, a 40 year-old man who had fitted outside a shop. I helped out but, again, didn’t have much to do with the patient.

Rail staff called us for a male who was fitting at a train station in south London but when I arrived, on the tail of an ambulance, the motorcycle responder told us that the patient had left the scene of his own accord. I know the area quite well and there is an alcoholic man who regularly calls (or has others call) ambulances for his alleged ‘fitting’ episodes. Sometimes he waits to be seen and sometimes he doesn’t. I suspect today, he didn’t.

Finally, just as I was trying to get back to book off, I got a late job. A 35 year-old male had been knocked off his cycle by a car. The car had hit him at speed as he attempted to turn right at a junction. The cyclist had allegedly cut across his path and been struck for his troubles. Again, strangely, a private ambulance crew (from the same company) had stopped and were helping him. The patient had neck, rib and hip injuries and was in a good deal of pain, although I doubted his life was at risk.

An LAS crew arrived and we got him collared and boarded and in the back of the vehicle while he sucked on an entonox mouthpiece to relieve his pain, most of which was coming from his hip joint. Other than that, he seemed perfectly stable.

I gave him morphine and he settled down in the ambulance. Then we set off for hospital, got him inside and I went back to my station, glad to be getting home, albeit over an hour later than I should have. Ambulance crews cop worse than me though, some of them will work a couple of hours overtime on late jobs and will still be expected to get in on time the next day for another twelve hour shift. Eventually, it wears you down, especially if one shift after the other has been like that.

Well, at least the first part of my day allowed me to mesh back into my role. I also got my new boots, so I can ditch the ones I have because they are worn through and I have been getting wet feet when it rains.

Be safe.

Saturday, 26 January 2008

Everything's big in America...

Hello. I’m back and I’m jet-lagged, as you can probably tell from the time of this posting.

I spent two weeks in Florida - Disney World to be precise. I’ve been there twice before; twenty odd years ago and again in the nineties when I took my son (and a few others) with me. I love the place and it has really improved in terms of value for money I think but I noticed a disturbing trend that I hadn’t seen before – lots of people who either couldn’t or wouldn’t walk around the parks.

I’ve told you all before that I spent the last year of university studying the trend for obesity and its possible consequences for medicine and particularly pre-hospital care. I’ve discussed it in the book and I make reference to it whenever I can because I still feel strongly about it. Now I have seen first-hand the dangerous changes that are taking place in one of the worst offending countries.

America has one of the highest growing populations of overweight and obese individuals. The USA’s National Centre for Health Statistics recently reported that 63% of Americans are overweight, meaning they have a Body Mass Index (BMI) of over 25 and 31% are clinically obese (a BMI of over 30). It also stated that childhood obesity has more than tripled in the past two decades. This is shocking but there are very good reasons why it is happening – not only over there but in the UK and many other developed countries.

Notwithstanding the odd argument about genetic propensity for fatness, our behaviours, opportunities for sloth and the easy availability of cheap and abundant food make us ideal candidates for an early death as a result of piling on weight. As simple energy-consuming machines, we are required to eat to create ‘fuel’ which is then used up in order to make life possible. Excess fats and sugars are stored by the body for later use, as and when required, which is useful when you are facing a cold winter and a depletion of natural resources for food. Body fat would be used to keep us alive until we can stock up on fresh food again. That’s the idea but it doesn’t work when the nearest source of food is the local Tesco and its open 24 hours a day. Neither does it help that today’s modern society actively encourages less physical activity, thus when you eat a certain number of units of energy, you use up less and store more.

Back to my Disney World observations. I noticed an excessive number of people using electric wheelchairs to get around. I can’t believe for one minute that they all had disabilities that made it impossible to walk – some of them were in their teens. A lot of them were wheeling about as couples. A few of them demonstrated their perfectly able bodies by getting out to walk to the food stands for lunch, only to return to their chairs afterwards. Most of them were obese.

Even more alarming was the sight of so many kids being pushed around in ‘strollers’ – buggies. Only a small number of them were of an age where walking would have been a problem; they either couldn’t walk yet or the distances would have been difficult for them to tackle on little legs. The vast majority were definitely old enough to get out and walk for themselves but the opportunity to be pushed around the parks by their parents proved too good to be passed up. Again, many of these kids were overweight or obese. I found it ironic that a few of them were being wheeled about whilst eating burgers and crisps, courtesy of their parents. Clearly the paradox now in play is that these kids will get bigger, thus heavier, thus less easy to carry, so the parents will simply continue to push them around because its a hell of a lot easier on their backs.

And here’s a conversation I witnessed on the bus between a four year-old girl and her father.

‘When we get to the hotel, we’ll be leaving straight for the airport.’

‘Yeah but you’re gonna roll me there in my stroller, aren’t you dad?’

‘Yeah, I can do that.’

The little girl was actually expecting to be wheeled from one place to another on demand. She will be eating the same diet as most kids her age I would imagine but she won’t be burning the excess stuff off and she will probably just get fatter until she no longer fits properly inside her stroller. A few of the children I saw inside these buggies were far too big to sit down properly and had to wedge themselves in side-ways.

Now I am not a skinny person who is finger-pointing at overweight people and I know that many of my readers may well (and statistically are) overweight or obese but when are we going to get real about this? It is an epidemic and it is killing people.

I’m also a realist and I know that overweight children (and adults if they want to) can and do lose lots of weight and become lean and healthy. I’ve seen it in my own family so it happens but it’s not a social trend. How on Earth is the USA going to put together a standing army to defend itself in the future when most of the kids in its population are just too fat to fight? The same applies to us.

Inside and outside Disney there are a few ‘alternative food’ stands scattered about and you can get apple slices or carrot sticks instead of chips if you want but most of the stuff on offer is heavy, fatty and completely unhealthy if you are already overweight. Burgers, fries, coke (I didn’t see much diet coke anywhere) and large portions of chicken are much more easily bought than fruit or salads. In fact, on a trip to SeaWorld, which is not owned by Disney, I tried to find a place where I could eat something healthy and the one and only salad bar they had was shut (probably due to lack of interest). Getting alcohol is often difficult and you are going to have your ID scrutinised if you look younger than 21 - they are very hot on this, yet over-eating is probably now a bigger potential killer than drinking booze.

Inside the parks, one of the most popular items on sale to eat on the go is smoked turkey leg. I have no idea of its calorific value or how fatty it is but for me it would be a two day meal. In fact, I couldn’t finish many of the meals I had over there, not because the food is unpalatable but because for a little Brit like me, it was just too much in one serving. Even the cakes and sweets are huge and, regardless of my sweet tooth, I couldn’t bring myself to try any of them – they looked too sickening.

This problem is entirely reversible but the giant food-churning corporations are making billions from our laziness. Fast food tastes good when you are hungry and it suits busy lives. I know this myself of course because sometimes I have to eat the stuff during heavy shifts but that supplies me with the energy I need to get through a 12-hour day, much of which will involve physical activity, so I feel confident that I am ‘burning’ off at least as much as I shove in. My weight hasn’t changed much over the years and apart from my well known chocolate habit, which I am addressing, I only eat when I am hungry. I try not to eat too much too often. It’s that simple.

Maybe an anti-snack patch needs to be developed, much as nicotine patches can dampen the desire to smoke. It could be slapped on the arms of every fat child who refuses to get off their wheels and walk. They might eat less, lose weight and realise they feel better for it. Or maybe that would just be another way of pandering to a lazy population. The fact is things are too easy, especially for people in developed countries: Lots of cheap food, available any time you want it, loads of excuses for not exercising and a trend for staying fat once you are fat. I’m even convinced that it is less of a stigma for children now because they are almost in the majority wherever you go. We might soon be hearing ‘thin-est’ jokes and my whole argument will be burned with all the research that has gone before as day by day the population dwindles and the healthcare bill grows. Who needs a war? We have food.

So, what’s the magic formula that will save the lives of hundreds of thousands of people who are too fat? Eat less, exercise more. Less in than out...or at least keep it balanced. For the kids of America I have this to say: get out of your strollers! Start a revolution and shock your parents. Convince them that you can and WILL walk around the Disney parks or wherever it is you are going. Walk until you are tired and need a nap. Walk off the fat and give yourself a healthier heart. Spend less time on your play-stations and more time playing real sports.

Our kids aren’t far behind, so we better keep an eye on this because it will get worse before it gets better.

If you want to check your own BMI click here. It’s not definitive by any means but, if you are honest about your height and weight, it will give you an indication.

Usual postings will start again shortly. I have a few from December that didn’t get published so I will do that over the weekend. I’m back at the helm next week and should be posting new stuff regularly. Thank you all for your kind comments about the book and my well-earned rest and please, keep everything I write in perspective.


Wednesday, 2 January 2008

Happy New Year

The London fireworks are amazing. This was the first time I had seen them. I've heard them often enough but I've usually been bent over a drunken person who is vomiting on my shoes as the chimes of Big Ben ring out. Happily, I had the night off this year and went to see the display and thoroughly enjoyed myself.

Yes, I had a drink but not enough to put me in the back of the Booze Bus. How embarrassing would that be? I don't drink a lot anyway.

Now I said I was about to go on extended leave and I am. I was ill on New Year's day because I have been trying to throw off this stupid man flu I've got, so I wasn't on duty in the evening (nothing to do with my New Year's eve, honestly). The rest has helped recharge a battery but I need a total MOT, so I will be unavailable until the end of January. No more posts 'til then I'm afraid, although I have a few waiting in the wings which I never got around to writing up!

I'm back on duty on the 30th of January, so I will start writing again after that.

Many thanks to those of you who bought the book. Thanks for the positive reviews you've given me (don't forget to write reviews on Amazon and Waterstone's websites - it all helps sales). I walked into a bookshop in Charing Cross Road and it was staring at me from the 'favourites' At least I know it's getting out there.

If it does well, I will write some more but that will be down to sales. Business first for publishers you see.

So, thank you for reading this blog and have a great January. I'll be back soon...

Be safe.