Saturday, 9 February 2008

Under the radar

Eight calls (but it felt like a lot more): two refused, one false alarm, one possible hoax and four by ambulance.

Thursday nights are usually busy. This is the first night of the unofficial weekend when students with nothing to learn on Friday, the unemployed benefit-wealthy and seasoned clubbers get together to make the West End a noisy place. Strangely, I prefer it that way, even though there will be virtual no-go areas for young people by about 3am (when the nasty elements prey on the drunken innocents).

It was also a clear and quiet night weather-wise; stars in the sky and no wind at all. The winter chill was barely perceptible, which explains why a lot of the fun-lovers out and about chose to wear their summer clothing.

Of course, there was no chance of completing my vehicle and equipment checks before the first call came through. I was off to see a 25 year-old man about his epileptic fit. He was at work in his City office and his anxious colleagues were buzzing around him as I attempted to get some answers about his condition from him. He had fitted for 2 or 3 minutes, according to his friend but now he was recovering – he was still a bit confused but he could talk to me.

‘I take epilim’, he told me. This is the medicine he needs to take regularly to prevent a fit from occurring.

‘And have you taken it today?’, I asked.

‘No, I’ve missed it for the past couple of days’.

That’ll be the reason he’s had a fit then, I thought. I still don’t understand why people skip vital prophylactic drugs when they know what will happen when they do. I can’t believe its simple forgetfulness because taking the stuff would surely become second nature after a few years. Still, I guess until I am bound to take pills every day I will never know the reason.

The man’s boss was a bit nervy about the whole thing and when I told him that he had refused to go to hospital, he insisted on trying to persuade him to do so, even though I had just spent twenty minutes doing just that. It irritated me a bit to be honest. I suggested that further discussion could be seen as coercion and that the patient had made his mind up now, so it was up to him. I also said that I was waiting for the crew to turn up and maybe they could get him as far as the ambulance for further checks if need be.

This provoked a prickly response from the boss and he decided his duty of care outweighed mine. He even got on the phone to get ‘legal advice’ about where he stood. It was getting ridiculous.

‘Why don’t you just let me do my job?’ I asked as he dialled the number.

‘And I’ll do mine’, he said haughtily as he walked off.

Now, I admit, I may have rubbed him up the wrong way by being insistent about leaving the patient alone once his mind had been made up but I had my own plans for his care. There was a risk that he would fit again tonight but this had happened to him before and he had dealt with it himself, so there was no reason to badger him further. His boss had no authority to demand he went to hospital – it was best to leave it to plan B; the one where the crew get to chat to him before we all left him in peace. Nothing bugs me more than people who call ambulances and then believe they can do a better job than the people who turn up in uniform.

In the end, the crew couldn’t talk the patient out of his decision either. He agreed to go home with his friend and call an ambulance if he felt unwell at all later. The boss man was silent now.

A run across the length of Euston Road for a 60 year-old man who had collapsed next. He was drunk and a group of Polish men had gathered around him to standing around him. I got the man to sit up and asked him my usual questions about his drinking habits and how much he had consumed tonight, etc. Then the crew arrived and plucked him from the road. Now he will get a free ride to hospital, a free bed and a free doctor to make sure he is free of disease.

As soon as I ‘greened’ up I got a call which took me all the way back across the Euston Road to Mayfair, where a 35 year-old with a nut allergy was having a reaction to...nuts. Incredible.

When I arrived he was walking out of the restaurant to meet me. He was rubbing his throat but didn’t look distressed at all. I got out of the car and confirmed that he was my patient.

‘Do you have an Epipen?’ I asked.

‘No’, he replied.

Usually (but not always), people with life-threatening anaphylaxis will carry a prescription Epipen or Anapen, containing Epinephrine, which they can self-inject to slow the reaction down and buy time before the ambulance arrives. So, those without it are generally (but not always) safe and will usually be having a mild reaction which can be reversed using an antihistamine.

His neck was red and he said that it felt a little swollen inside his throat. Apart from that, he was stable and not in any clear danger. However, anaphylaxis is not to be underestimated and the very fact that his throat was swelling meant he could become acute within seconds.

The ambulance crew took him to hospital where he will probably be put on an antihistamine drip or given a couple of tablets to swallow, if his throat isn’t too bad.

A drunken tumble down a couple of concrete steps at an underground station next and I found myself looking at a pair of dry-skinned, flaky feet for evidence of injury. The 65 year-old had missed a step as he walked down towards the entrance. He had fallen clumsily and twisted his ankle. His right foot was painful, so I looked at that first – he had a slightly swollen ankle. Now I had to look at the other foot and compare them. I don’t mind this procedure at all but it is most unpleasant when the patient’s feet are unfit. I have colleagues whose worst nightmare is other people’s feet - they'd rather scrape a body off the ground than deal with smelly, yellow feet.

The man had a grade I sprain, so nothing to worry about but he would have to go to hospital to get it examined properly. Although he had been drinking, he wasn’t too worse for wear. He could weight-bear on his injured foot, so he was limped out to the ambulance.

My next call was for a 2 month-old boy who had stopped breathing and become floppy for a short period. I arrived to find his mother holding him and his worried family gathered around. They were a large, friendly Pakistani family and I was the only one in the flat with footwear on, so I apologised for the intrusion of my boots.

The baby had a history of breath-holding, resulting in periods of apnoea and the hospital had found no cause for it. He was giving his parents regular frights but I reassured them that this was normal for many children and the problem was still not fully understood. The child was wriggling and smiling now, so if there was any danger, it had passed. The mum knew the baby was fine now and she was happy to let me and the crew, who had just arrived, carry on with our shift. Of course, she could call us back any time she felt worried but I knew that the family were going to have to cope with this until the child simply grew out of it.

‘Would you like a cup of tea?’ the child’s father asked as I prepared to leave.

I politely declined. I have yet to enter an ill-mannered Pakistani household.

The night took a bit of a dramatic turn after that. As I headed back to my station and midnight approached, I listened to the voice of another FRU medic as he demanded urgent police assistance. This usually means someone is in trouble or imminent danger. Then he disappeared because the dispatcher on the other end of the radio kept trying to call him back but he didn’t reply. I could hear the tone of the dispatcher’s voice changing as she became more and more concerned. On other shifts I have heard them try to call someone back on the radio and there has been no reply because the FRU medic has left the vehicle after waiting for a response but getting none; I’ve done it myself when on scene. Sometimes you just can’t sit around waiting for them to get back to you. You will hear slight annoyance in the voice of the dispatcher as he or she tries, in vain, to raise someone. This was different though, this was genuine unease.

My radio frequency is set for the Fast Response Units (FRU) only, so every conversation I hear is between Control and a fellow FRU pilot. I sat in the car outside the station waiting, like everyone else who had heard this exchange, to see if the call sign would respond – nothing happened and I imagine the police and an officer or two (and probably the nearest FRU to him) were currently speeding to the scene.

Just as I listened intently for a change in the atmosphere, I received a call for a 25 year-old female who had called her boyfriend up north and told him she was in Regent’s Park after overdosing on pills and alcohol. The information had been relayed to us by the local ambulance service up there and I was being sent to investigate. The message also contained the words ‘pat is violent’.

I tried to get through to Control so that I could clarify the details and get some back-up before I went to this job but they were too busy with the FRU bod who was MIA, so off I went, deciding to be cautious when I got there. I drove through the park and into the inner circle, which is a road that encompasses the park area itself, like a cordon. It was very dark and very, very quiet inside there.

Control called me on my ‘phone and I asked for police back-up. I was told that an ambulance was currently doing a circuit of the outer ring; a road that runs around the perimeter. It would take them a while because that was a long road. I was advised not to approach the woman if I saw her. I didn’t need the warning; I had no intention of going forward in this pitch black place.

As I toured the inner road, using my alley lights to illuminate the pavement and park each side of the car, I spotted an open gate. This was strange because the park is locked up by the police at night. It was almost midnight, so this gate should have been secured with a padlocked chain. As you can see above, it was ajar and almost inviting me to go in. Beyond the gate was nothing but the night and I wasn’t venturing into it. This unstable call had been made by an unstable person and I had no idea what she was capable of – the fact that she was known to be violent was enough to keep me on guard.

I called Control and asked them to direct the crew and police to where I was because I believed that she would have entered the park at this point, if anywhere. Now she could be hidden in the dark somewhere in the vast garden, dead or dying...or simply waiting for some poor fool to happen by.

I waited and watched but nothing stirred. I had no idea what I was going to do if someone appeared from the shadows and walked towards me. I guess I would weigh up the threat and deal with it as it presented itself.

Ten minutes later, the ambulance arrived and we waited for the police, who arrived a few minutes after that. There were three of us just prior to the police arriving, so the crew had gone inside the park using their torches to light the way and I was behind them in another area, using my little alien face torch, with its bright blue light, to see ahead. I don’t have a proper torch and the car isn’t kitted with one (the ambulances are). Every Maglite I’ve ever owned has either failed on me or broken because of the stupid twist-head design of the on-off mechanism. So, I am reduced to carrying a Christmas present. It’s useful but it switches itself off every five seconds, which is frustrating.

The police joined us and we searched and searched. The patrol car drove inside and they used a thermal camera to pick up any heat source. The police helicopter, India 99, was going to be deployed but it was currently busy, so we had to make do. Nothing was found but the park is huge, so it wasn’t going to be that easy.

The girl’s mobile was called again and again by ambulance Control and the police but it went to voicemail. Then, after an hour on scene, the police got through and the girl told them she was at home. An address was given and I was sent to check it out. The ambulance and police were going too.

When I arrived at the address I realised that I knew the street. I had dealt with a suicidal girl here almost a year ago (in fact, I posted it on this blog). She too had called her boyfriend just before taking a load of pills and alcohol. I even remembered the house but the address I was going to was across the street from it.

A police officer met me and, together with his female colleague, we went into a block of flats. We couldn’t find the light switches and had to walk up each flight to the top in total darkness. Given the nature of this call and the fact that we knew her to be violent, this wasn’t helping the atmosphere. I deployed my little blue alien torch and that made us feel a little safer.

Once at the door of the given address, the policeman thumped it hard. A male voice inside called out ‘who is it?’ and several doors started opening around and below us in the building. A Chinese man appeared at the door, he looked bewildered. We knew the suicidal girl’s name, so the police officer asked if she lived there. Of course she didn’t and unless she had a Chinese boyfriend who lived up north, there was no chance she would be in there. It just didn’t look right and the three of us looked at each other with a ‘we’ve been had’ face on.

The other doors had opened to spill out more Chinese men, all of whom seemed concerned about this sudden rude intrusion.

‘Happy New Year’, I said, hoping to diffuse the tension. They smiled, so that was a good start, I reckon.

It turns out they are all working with the Chinese Embassy and this block of flats houses no-one but them, so our mystery girl was lying. I wondered if she was the same person I had taken out of the house, drugged and seriusly ill, across the road last year? When we got back outside, there was a man standing in that very doorway, watching us. How strange. He was asked if he knew the girl but he denied any knowledge of her. Meanwhile the crew had arrived and had heard the commotion inside the building. They had thought the worst and called Control to report it. I then got a call from the FRU desk asking if everyone waas alright and I explained what the noise had been (us inside).

So, we had either been party to a huge and expensive hoax or she was lying in a ditch somewhere having fooled us all into leaving her alone in the park. I didn’t know but two things had a coincidental ring to them. One was that address and the suicidal girl (who had been Chinese, incidentally) from last year and the other was a hoax call I attended at a men’s hostel a few years ago. On that occasion, the call had been made to an ambulance service up north and relayed to us. It was also for a female who was suicidal.

The night rolled on and got busier. Drunken people were now spilling out onto the streets and genuine illnesses were being reported. Then the computer system which conveys calls to us crashed completely. Control could no longer ‘see’ where all the ambulances and fast response units were. Calls couldn’t be sent to our MDT’s and satellite mapping was out the window. Tension was palpable on the voices of the dispatchers as they struggled to gain control over who was where and what was being done. We had to revert to the old system of calling in our status by radio or ‘phone and taking calls ‘manually’; writing it all down and finding our way to the addresses using an A-Z. All very well but I didn’t have an A-Z in the car. There’s never one in it, although there should be and I'll be damned if I can ever find one when I look.

Luckily, I know my way around now, so taking street names was going to be no problem, so long as the calls were in my area. Fortunately, the next call I received was. I was to go and help a 48 year-old drunken man who had collapsed outside a Chinese restaurant. He was completely out of it when I arrived and his friends were worried that they couldn’t rouse him. He responded to deep pain but just wouldn’t wake up. I also found him to be very cold (34.5c) and bradycardic (a pulse rate of 33). This was not good and, unless he had a predisposing medical condition I didn’t know about, he was suffering from hypothermia. But he had only been on the ground for ten minutes, according to those around him, so this sudden hypothermic state was strange.

I called for an ETA on the ambulance but was told there was nothing available. The problem with everything being under the radar is that nobody knew for sure what was available until crews called in. We were also being swamped with resource-draining calls to drunks, fights and falls that needed no more than first aid attention.

After waiting almost half an hour and calling in twice more for help, I decided to treat the man on the street. I’ve done this many times before, especially in the busy summer weekends when waiting for an ambulance becomes the norm. I put fluids up to ‘revive’ the man; the saline would help to wake him up enough for me to safely manage him. The fluid was also fairly warm, having been in my bag in the car all night, so it should also help recover his temperature and heart rate. A blanket was placed under him earlier on because most of the cold would be going through his body directly from the ground, and several blankets were on top of him.

As people left the restaurant, there were looks of disgust and head shakes of shame. Most people can still go out for a meal and a drink without ending up in this state and with the press (and people like me) highlighting the nation’s drunken behaviour, more and more MOPS are looking at inebriated individuals with fresh and disapproving eyes. Soon, with any luck, it will become uncool to get too drunk to walk.

The ambulance arrived after an hour of waiting and the man was still out of it but when my colleague provoked a little pain, he sat up and became a conscious person again. The IV fluid had done the trick. He was helped to the ambulance to warm up and advised to go to hospital but he wasn’t interested, so I removed the cannula from his hand and he was allowed to stagger off with his friend in search of a taxi.

I felt sorry for the Control staff tonight; they were struggling at times to make sense of where everyone was and what they were doing. They were relying solely on the goodwill and honesty of the crews and FRU bods. They weren’t disappointed. Calls were going in regularly as we greened up and made ourselves available. In the end, we are all on the same team and their stress is just as real as ours.

On my way back to the station, I was asked to assist a crew who were dealing with an awkward extrication from a club near Leicester Square. I had heard them on the radio requesting another crew or a Delta Alpha (emergency doctor) to help them out but that was almost an hour ago now and I was shocked to find out they were still stuck with their patient, who had a serious head injury after falling off a balcony and hitting several hard objects on the way to the floor.

I raced to the scene and saw that another crew and FRU were already there but it still wasn’t enough. It took eight of us to get the man upstairs and out of the club. He wasn’t very heavy but he was a little combative at times and the stairs were narrow and winding in places. So, three ambulance crews and two FRU’s were out of action for some time while this one drunken head injury was treated and taken to hospital.

I had a night of strange and sometimes threatening events and we had a system crash but we pulled together and sorted it out, EOC and us (the grunts on the frontline). In the morning as I headed back to base to go home I called in X-ray (which means I am off duty) with no rest break (which means I get to go home 30 minutes early).

‘Thank you very much for all your help’, the radio voice said.

I know she meant it and I felt appreciated for the first time in a while.

Be safe.


Katie said...

If you feel healthy, it isn't normal for you to sit and think "I need to take these drugs," especially if they've got a lot of side effects.

Say, for example, you have a throat infection and are given antibiotics. You remember to take them because your throat feels sore and it triggers your memory. When you start feeling better, you lose the trigger and so it's much easier for you to forget to take them. I'm guessing this is why so many people don't finish the whole course of antibiotics.

It's the same with long term conditions such as asthma. It's easy to remember to take your inhaler when your chest is tight or you feel breathless but when it's well controlled, you feel healthy and there is nothing to trigger your memory reminding you to take it.

In most cases, I think it is down to simple forgetfulness unfortunately.

Anonymous said...

You should get the larger D-cell Maglite torches. These use a button to turn on/off, are very powerful and are heavy enough for self-defense should the situation demand it. The smaller ones don't really stand up too well with heavy use. I use a 3 D-cell version and can highlight a tree with the beam well over 100m away.

elmblog said...

Hey Xf, how about posting a picture of your funky alien-torch - sounds like a nifty little thing :)

What happened to your 'missing' FRU colleague, did he turn up unscathed? I do hope so.

miss emma said...

great post as usual and im glad you got back in one piece again!

but you didnt tell us what had happened to the other FRU bod. or did i just miss it?

microgirl said...


I'll second the forgetfulness aspect of regular drug-taking. When I was on the Pill I forgot at least once a month, and now I forget my anti-depressants at least once a week :)

I hope the MIA FRU lad was alright. Unless I just managed to misread your post and you did actually mention what the story was :)

Sam Tyler said...

Xf do you think the FRU call could be linked to this post?

With regards to the torch I gave up on maglites a while back when I discovered SureFire. They're fantastic slightly expensive but the size of a regular torch but it had a longer range than my old 2D cell mag and they fit nicely on your belt

Top post buddy

Robin said...

...Or you could get one of those funky head torch things and then you wouldn't need to hold the torch in your teeth when you need both hands free!

Hello Again! Glad to have you back blogging again :o) - I've just caught up!!

Robin said...

PS thursday night is also the night before those that live in other parts of the country go home for the weekend - friday night is travel night!

Joe said...

Maglite are aware of the problem that the twist-head function causes. You can buy (I know!) an adapter for it that moves the switching mechanism from the head to a push-button on the tail cap.
You can also upgrade the bulb to an LED, leading to a much brighter (and longer-lasting) experience.
Or you can get the same kit in a lot of markets, or on ebay for less.

Alternatively - surefire are great, albeit a little more expensive.

Anonymous said...

Yay! I'm a fish!

Sue said...

I used to take 40 pills a day and sometimes you do just get fed up with the whole thing, especially if they aren't making things better, but just keeping you out of hospital for an extra few weeks. It's to easy to just not bother for a few days. Obviously not a good idea if you have epilepsy, not as vital with UC as you get a wee bit of notice before your colon perfs!

PS. Really gald you are back blogging. January was a long month without you!

Xf said...

Thanks for the comments on regular medicine regimens. I do understand these arguments, I just think I'd be too damned scared to 'forget' my life saving meds. As I said though, until I'm in that position I can't condemn it but I will still nag people who leave their asthma inhalers at home because they think they won't have an attack...

Xf said...

And thanks for the Maglite comments; I got a lot of emails about it too! I will try a few of the suggestions out. I'll also try to remember to post a photo of my alien torch if you want to see it :-)

Xf said...

I still don't know what happened to the FRU pilot who called for help but I haven't heard anything bad so I can only presume that he was rescued from his predicament.

And Sam...I'm pretty sure you overheard the same call and that some of your colleagues assisted him. I have been pulled out of trouble by the boys and girls of the Met a few times myself. Thank you all.

Fiz said...

I have severe allergies and have an epipen. I can't believe the "nut" case! I read some US hospital book (true) where somebody did the same thing and he died I can think of more pleasant ways to die than by anaphalactic shock!

Anonymous said...

It is simple forgetfulness (I take 3 tabs a day for IBS - mebeverine) and if i've had a bad day, or couple of days ill take them on the hour every 4 hours. After that and i start to feel better, i do take them more and more spaced out, may forget one or two, or forget all together.

It's a right pain when you go back to the doctor about 3 months later for a 1 month prescription (And they ask awkward questions like - why didnt you come back earlier!)