Wednesday, 6 February 2008

First night

Five emergency calls: one cancelled on scene, one conveyed by me and three taken by ambulance.

My first run of nights since returning from leave and I was tired before I started – not a good thing if I am to last twelve hours. Of course, I’d feel better when I finished, got home and slept for six hours or so. Then again, that only works is Scruffs isn’t jumping on me to keep me awake because he’s bored!

I drove over the bridge and got my first call of the night in Holborn. A 78 year-old man had collapsed and passed out during a dinner function at a hotel. A doctor was on scene with him, according to the details on my MDT. Sometimes that’s good, sometimes it’s not – it all depends on how involved the doctor wants to be, or how dramatic his behaviour will be when I get there.

I went upstairs to the function area and saw the patient sitting in a chair with a tall, elderly gentleman beside him. This would be the doctor, I presumed. It turns out he is a retired Cardiologist and he was very helpful; he gave me the basic details and let me get on with my job. Almost without exception, my colleagues will agree that there is nothing more irritating than a high-browed medic trying to interfere with the smooth running operation that is routine pre-hospital care. I’ve had my fair share. This time, however, the Doc offered nothing more than his opinion on the quality of the patient’s pulse, on which, as a Cardiologist, he would have definitive insight I guess.

The patient was pale but seemed to be recovering from his episode. He had suddenly collapsed and become unconscious for two or three minutes, according to the Doc. Now he was vague and struggling to remember the simplest things, like the month and year. He had delivered a lucid speech half an hour or so ago and when I was introduced to his worried wife, she confirmed that he was normally sharp of mind. This wasn’t like him at all.

The crew arrived as I continued my obs. and the patient was improving by the second but his age and the fact that this was a singular experience for him, meant that he would certainly be going to hospital. An ECG would probably be quite revealing and the crew took him to the ambulance to be checked.

‘I’ve lost a little part of my life’, he said as he was taken away.

I’d never heard anyone express that about a faint before. Then again, I suppose the first loss of consciousness in anybody’s life must feel like that; no memory of what happened and a foggy understanding of what's going on when you recover.

My next call was to a 35 year-old male who had been hit by a bus. A call like that sets off the HEMS alarm bells and I was asked to report when I got on scene. I was already with the patient when I was asked, in fact, and he was lying on the pavement, surrounded by City Police, his head being held by an off-duty nurse who knew better than to let him move his neck.

There was a pool of blood next to him but nobody seemed to know where it had come from on his body. Neither did anybody know what had happened to him, although the bus driver thought he might have hit him (with his bus, I assumed). His face was bloody and his nose looked squashed but I didn’t want to insult him by judging the shape as abnormal too quickly, so I let the nurse stabilise his head and neck while I assessed him and tried to find other injuries.

He had been lucky; it seemed his only injury was to his nose, which may have been broken when he walked into the bus or the bus walked into him; we’re not sure which way round it happened. He was drunk – that much I did know and it isn’t unknown for liberally inebriated souls to walk into the path of vehicles. On this occasion, he chose a large, heavy mode of transport that just happened to be slowing to a halt at the point of impact, so his injuries would be confined to the area hit. No need for HEMS then.

The nurse told me he had initially complained of neck pain, so he wouldn’t be moved and when the crew arrived a collar and board were deployed. We never forget that, regardless of the relatively low velocity of some impacts, being drunk has the disadvantage of masking pain and injury. So he was ‘packaged’ and taken off the street. The pool of blood had come from his ruptured nose, I was sure of that now and the police requested a specialist cleaning team to come out and take care of it. I wonder what we pay these clean-up crews.

A 70 year-old man who collapsed half way in and half way out of a lift apparently refused any help and recovered enough to walk away, so I was cancelled as soon as I arrived on scene. The crew were already on their way out of the building when I pulled up after driving 3 miles through very heavy rain. As I sat in the car doing the inevitable paperwork, I mused on what he must have looked like lying there as the lift door closed and opened time and time again. ‘Doors closing....doors opening’, the posh lift voice said repeatedly.

I got back to my station and poured myself a cuppa after that. I sat down and watched a bit of TV with my colleagues until one by one, we were called out to work the miracle of medical care on the world outside.

Unfortunately, my patient was 20 years old and couldn’t manage a tummy bug without having to dial 999. Well, the underground staff called an ambulance for him (at his insistence). I sat with him as he discussed his symptoms. He complained about how ill he felt but he was still going to try and get to work. He had been lying in bed all day, periodically rising to vomit and clear diarrhoea. Yet, he still came into town on public transport to start his night shift. Now, of course, he wasn’t feeling right at all and thought he might vomit some more. I have my new boots on and I will never forgive anyone who taints them until I have broken them in.

‘I could take you to hospital myself but you’ll wait for a few hours because you’re not an emergency’, I informed him. ‘Or you can go and see your GP in the morning’.

‘I’ll see my doctor then’, he said after showing his disgust at the length of time he might have to wait. How dare the NHS prioritise patients in life and death terms; surely his illness warranted immediate attention? I was looking at a hopeless case.

I was about to get my paperwork sorted for him when he changed his mind.

‘Can you take me to hospital?’

I think I looked up at him in slow motion. The underground manager looked over at him too. Go home and get over it, he must have been shouting in his head - I know I was.

‘Yep. Let’s go then.’

I had cancelled the ambulance earlier when I realised the young man was healthy but sick, if you know what I mean. The crew turned up at the entrance to the station as I walked out with my patient, however. I explained what I was going to do and they were happy to be freed up to do something more important (if that was ever going to happen tonight).

I took my charge to hospital, sat him out front and there he waited, just like I promised he would. I used the excuse to go to the loo and have another cuppa...in that order. There’s no logic when it comes to coffee.

While I was there, I watched as the security guy searched a man who had been taken into one of the department’s secure rooms (mainly used for psychiatric evaluation). I could see what was going on because they have CCTV monitors set up on the nurse’s station.

The security man appeared at the desk a few moments later and handed two items to the nurse in charge. I was horrified to see what this man had brought with him to hospital and I realised just how important the security guy’s job was for the staff...for all of us in fact. In his hand were two knives, one inside a sheath and the other, a long fixed blade, ready for immediate use.

As I drove around the West End I came across a new face on the street. He was walking up the middle of the road, begging from the car drivers, none of whom gave him anything for his trouble...or the risk he was taking. So, as the cars swerved to avoid him and I approached, I slowed down to chat to him. My advice about walking on the pavement fell on deaf Irish ears, so I gave him what loose change I had and he thanked me for his future meal. He reeked of TCP; he was obviously obsessed with cleanliness...or he had a strange and rare fetish, but it was twenty minutes before I could no longer smell it in my nostrils.

A few hours passed by and nothing happened (not to me anyway, the ambulance crews, as usual, were busy). I copped a couple of far away calls from FRED and ended up asking if each one was for me or not. Most of them weren’t, so I saved fuel and the inconvenience of the public by getting them cancelled before I took the trouble of running too far on them.

Our regular hoax caller was at it again and he has a new year with lots of new crews to play with now. I doubt we’ll ever catch him but if we do, I want to be there.

My last job of the night was for a 53 year-old female with chest pain. She was standing against a wall outside a callbox when I arrived in the wee small hours.

‘I’m not feeling well’, she said in a quiet, almost whispered voice.

She didn’t have the look of a cardiac to me – she looked depressed. I went through my routine and showed sympathy and care of course but I don’t think I could have helped her with her real issues, which were psychological in my opinion. The crew arrived a few minutes later as she was getting warm in the back of the car and I handed over. She was gently moved from one vehicle to the other and her contest for a happier life continued with two more strangers.

Be safe.

9 comments:

Tabitha said...

You could always get a friend for Scruffs!

What is the recommended procedure for patients with psychiatric problems? eg. If someone is suicidal should they call 999? What sort of treatment do they receive once they get to hospital?

Fiz said...

How come the Underground staff get away with calling you when they obviously didn't need to? It seems to me that the only real call necessary was the first one. If you waste police time, you get called on it, so why can't they do the same for the Ambulance Brigade?

Sam Tyler said...

Another good post Xf

In my experience TCP is used to mask the smell of alcohol - especially those alcoholics who still work

Konstantin said...

Hey, I am very curious about your working hours. i.e. how many hours a week are you supposed to work and if there is any overtime?

Xf said...

tabitha

Suicidal people dial 999 all the time. Hospitals put them under phschiatric supervision and they will be evaluated. They can also be 'sectioned', which means they can be taken to hospital for their own safety, whether they like it or not.

Xf said...

fiz

Unfortunately, if you insist on having an ambulance, the underground staff will oblige. They also have nowhere else to turn if someone is ill. I have a lot of good to say about underground staff, so it doesn't worry me.

Xf said...

sam

Good point. I'll bear that in mind :-)

Xf said...

tabitha

As for a friend for Scruffs...one mad cat is enough for me and I think he'd attack him now anyway.

Xf said...

konstantin

We work an average of 37.5 hours like everyone else but we do that on a shift rota, so I will do 12 hour shifts but not every day of the week. Some weeks I'll work more hours than others but it will average out across my rota to the national standard.

Yes, there is almost always overtime available but some of us (me included) travel too much of a distance and are too tired on rest days to bother!