Sunday, 30 March 2008

Doctor Duck

Twelve calls; one hoax, one gone before arrival, one home by taxi and the others went to hospital by ambulance.

I started my run of four nights tonight. I never look forward to this part of my rota; it’s demanding, tiring and sometimes soul-destroying because it spans the entire weekend...and summer is just around the corner. Summer means more booze, more drunks and people staying out much, much later in the day.

I don’t sleep well during the day when I do nights, so after about the second or third shift, depending on the workload, I begin to look haggard I think. Still, it’s not all about image, right?

A 55 year-old man had a seizure of some kind on a bus; he had no history of epilepsy but witnesses told me that he was definitely fitting. I found him sitting on a seat near the back, confused and unable to answer the simplest question, like ‘what’s your name?’ He would try, then fail and look frustrated. He was either post ictal or he had suffered a neurological event, possibly a TIA.

I sat on the bus with him for almost 30 minutes before an ambulance arrived (that’s always the first indicator of the kind of shift I’m going to have) and it took a lot of persuading to convince him that he needed to go to hospital. By this time my obs had been completed twice and he was recovering enough to make sense, although his sentence completion skill was still fragmented. The crew led him to the ambulance and he conceded that something was wrong – they took him to hospital to find out what.

A call to an ‘unknown female’ (that means we don’t have an age for her) with diabetic problems, ‘collapsed, now unconscious’ took me to a hotel room in Euston. The woman’s friend was in the room with her – they were both middle-aged and were visiting London to see a show. Unfortunately, that plan had been scuppered by the woman now lying on the floor, conscious but extremely agitated.

‘She used to be a nurse’, said the friend, ‘She’s been feeling unwell all day, then she suddenly fell down.’

This woman had no medical problems and the issue of diabetes was irrelevant – she wasn’t a diabetic. She lay there shaking and moaning. Every now and then, she would clutch at her throat and say she couldn’t breathe. Her sats were high but I put her on oxygen while I fathomed this one out. Everything about her screamed neuro and, although the rest of her obs were normal, I couldn’t help thinking I had seen this behaviour before. I suspected another TIA and when the crew arrived they agreed. It was impossible to get the woman to comply with any instruction – even opening her eyes was difficult; you could see her trying but failing to get those lids to pop up on demand.

She was taken to the ambulance and I got IV access in case she decided to go off on us. She was still shaking and fairly non-communicative. Her concerned friend went with her to hospital and I watched as the doctor carried out more tests to see what was going on.

My first drunk on a bus tonight and it was a five foot tall Polish man who just refused to budge. He’d open his eyes when I asked him to, then he’d shut them again when he realised I was irrelevant to his stuporous world. It took the combined efforts of the police, who arrived five minutes after me, and the crew to remove him by walk/dragging him into the ambulance. He was far too incapable to be left anywhere. Oh, and we knew he was Polish because he swore at us all in Russian and nodded when asked if he was ‘Polski’. It’s a sad state of affairs when we start learning Russian expletives simply by hearing them so often.

I thought I was going to a drunken male who’d passed out when I got a call to attend a 35 year-old man who’d fainted at a railway station but he walked out to meet me, which surprised me.

‘Are you here for me?’ he asked as I unloaded my stuff, ‘I fainted in the toilets’. I guessed it must be him.

I sat him in the back of my car while I carried out obs and when the ambulance arrived a few minutes later I walked him over to it. We listened to his story and got more and more suspicious about his condition. He had been sitting on the loo and suddenly passed out, recovering a few minutes later. He had never fainted before and he had no medical problems whatsoever but now he told us he ‘felt weird’. He looked pale and unwell, so we looked at his ECG. The delay between his ventricular contractions and the resetting phase of his heart was too long and this is known as Long QT Syndrome if persistent. I have seen a few of these cases but they are relatively rare and I could be wrong but I was confident enough, given the circumstances, that this was what I was looking at.

I can’t treat this condition unless it deteriorates and there is always a risk of sudden cardiac arrest, so we got him to hospital promptly. I’ll try and chase this one up to see if I was correct; it’s always good to know whether a diagnosis like that has been confirmed or denied.

I went to an all-girl fancy dress party next. Out in the east, a 21 year-old who’d had too much to drink collapsed in a heap in her bedroom. The party was in full swing at the little flat, shared by students, and I found her vomiting into a cooking pot. I do hope they don’t use that again.

She was very drunk, even though, as usual, her friends swore blind she’d only ‘had a few’. The crew arrived to pack her off to hospital and as we picked her off the floor, I noticed a lost tail on the floor (from a costume someone was wearing obviously). I picked it up and asked if it belonged to anyone. I tried to match it with the appropriate outfit but they were all dressed as animals and most of them required a tail. It was too confusing, so I left it where I found it.

As she was made comfortable in the ambulance, her friend came up to me and said ‘So, what’s wrong with her?’

‘She’s drunk’, I said and with that I left the scene. Her friends had that ‘drunk? Surely not’ look about them.

Back in the east, after returning to my station for a couple of minutes, for a 46 year-old man ‘fitting’ in the street. After an area search with the crew, who arrived shortly after I did, we found him. He wasn’t fitting. He and his alcoholic mate had been staggering about and he’d fallen. A MOP had called us because he was concerned that the man was epileptic and while I don’t deny he could have had an alcohol-induced seizure, he was in fine fettle now, as he and his friend chatted to the ambulance crew about their woes. I left them to it.

A hoax caller from Luton has been allegedly harassing a couple living near my home station. He ‘phoned them at home, demanding that the man’s wife join him in Luton later on, or he would kill himself. When she didn’t comply and their phone was unplugged, he dialled 999 and said that someone was having an epileptic fit at the address. Cue me and my yellow car.

The tenant of the flat was extremely apologetic when I buzzed for entry. ‘Sorry, this is a hoax call, we’ve been getting them all night’, he said with a fed-up tone.

‘Do you mind if I just come up and check that you are alright?’ I asked.

He buzzed me in and I went to the fifth floor. When the lift door opened he was standing at it with a sheepish look on his face. He was genuinely sorry to have wasted our time, even though he wasn’t the culprit. He took me to his flat and I met his wife. Both explained the situation and I bid them goodnight. As I left he called after me.

‘I have a heart condition and might need you guys sometime. Will this stuff cause me problems?’ he asked.

‘No’, I told him, ‘we’ll still come, even if your address had been flagged'.

Addresses are often flagged on the system if there is an issue we need to know about, such as a person who’s known to be violent. In this case, the address was known because of the frequent hoax calls directed at it. I felt sorry for that couple.

Three times I tried to get IV access for a 30 year-old female suffering sickle cell crisis; she had severe pain in her chest, back, abdomen and legs. I’ve seen a lot of this and the pain is genuine, usually scaled at 9 or 10 out of ten – the only effective relief for many of them is morphine and this is why I needed to get a line in. However, as with most of the sickle cell patients I’ve dealt with, access to a vein is never easy – they have been ‘got at’ so many times that they have worse peripheral circulation than a drug addict. On many occasions I’ve watched nurses and doctors struggle to find the best vein possible in the lower extremities; the ankle or foot is a favourite site but even then, there’s no guarantee of getting in.

I’d been with her for almost 30 minutes and she had to settle for the entonox I’d given her – it was reducing her pain score and that was the target – I just wish I could have done more for her on scene. When the crew arrived, she was a little more comfortable, although moving from her bed to the ambulance chair was going to cause some pain, so she continued sucking on the pain-relieving gas. Any good technician will tell you that the basic stuff, like entonox, is often enough for a call like this and paramedics often forget that they have a first line analgesic there. It’s easy to jump straight into giving IV pain relief but it wastes time while the patient is suffering, so they’re right, go for the good stuff first, if that doesn’t work or it’s not enough, then find a vein. She’d needed fluids too but the hospital staff were left to work that one out.

The most serious calls aren’t only sent to my MDT in the car; they are followed up with a phone call from Control. A 25 year-old man was trapped under a bus and it took me no more than three minutes to get there from the station. Police were already on scene and there were a lot of people milling about very close to the patient. I parked up and saw that a bendy bus had stopped close to the kerb and a few people were around a man lying on the ground – his leg appeared to be under the wheel of the vehicle. There wasn’t a sound from him as I approached.

When I got to him, I saw immediately that his leg wasn’t trapped but his jeans were torn away at the shin bone, revealing a pulped mass that was his lower leg. I quickly uncovered what I could of the wound and saw that he had extensive tissue and muscular damage, right down to the bone. Bleeding seemed under control and I tried to find out what happened but all I could hear was one voice ringing in my ear continually.

‘Are you a doctor?’ I asked the man who had given me the hand-over as I inspected the patient. He had gone into some detail in describing the wound and had begun to give me the man’s vital signs. He had forgotten, however, to tell me the patient’s name.

‘Yes, I am. I’m off-duty’. He then went on to tell me where he worked. His behaviour was strange and it was about to get stranger.

I spoke to the patient and he was very calm. He had been drinking and that may have acted as an analgesic because his injuries looked terribly painful and I expected him to start screaming at any moment but he didn’t. In some ways that’s good but it’s also ominous.

I grabbed my stuff out of the car and began cutting away at his trousers. I’d put him on oxygen and there was someone taking care of him at the head. The doctor told me he had used something to control the bleeding. He pointed to the limb and then I saw his handiwork. On the man’s leg, just above his injuries, was a very tightly tied makeshift tourniquet; a completely unnecessary device in pre-hospital care, except where bleeding is so serious that it can lead to imminent death. In this case, the leg skin and muscle had been sheared away but the major blood vessels were intact, as were most of the tendons and ligaments.

‘Do you have a cannula?’ he asked while I cut away the constriction he’s placed on the leg. I think he wanted me to give him one so that he could put it into the patient. Doctor or no doctor (no ID), he wasn’t touching the patient. The crew arrived and they got to work preparing the man for hospital. He was still conscious but we didn’t know how long that would last. His leg was in very bad shape and as we moved him out of the way of the bus, we could see that his ankle had also been badly damaged.

‘I’ll get this bus moved for you’, said the doctor without any request to do so.

‘No. The bus stays where it is, thank you’, I told him. Now he was beginning to annoy me.

I asked the police to get rid of anyone who wasn’t directly concerned with the incident. The crowds had grown around us and they were noisy; some of them were behaving very badly – taking photo’s, making retching sounds – that sort of thing.

I had cleared the wound area of clothing and the man had been moved back so that his feet were no longer under the bus. We had tied a secure dressing over his wound and were almost ready to go when I looked up to see the doctor’s head inches from mine. He was staring down at the injured leg.

‘Oh, that’s pretty bad, isn’t it?’ he said in an almost schoolboy tone.

Now I knew he couldn’t be for real. He was either in his first week at medical school, or he wasn’t a medic at all. This wasn’t the kind of behaviour I expect from a medical professional. He seemed to be there for the drama. Its high time doctors carried identification with them; everyone else does. I’m glad to have a doctor working with me but someone in the street who simply says he’s one is an unknown and potentially dangerous threat. A genuine doctor understands the need for a controlled system of patient management, especially on a scene like this. Real doctors deserve to be protected from imposters who are tarnishing their profession, so an ID card seems logical and unobjectionable.

‘Can you please move away from here, you’re breathing onto his wound?’ I said. He backed off, apologised and moved to the side of the patient for a look instead. I was seconds away from asking the police to move him along when he stood up and I got an excuse to get rid of him.

‘Thank you for your help, we’re fine here now.’ And with that, he walked off into the horizon.

The police had a proper cordon around us now and we could safely move the patient into the ambulance. It had to be done carefully because we still didn’t know if his bone had been damaged by the crush but it all went smoothly and a few minutes into our secondary survey in the back of the ambulance, there was a knock on the door. I thought I was going to see my 'doctor' friend again but it was a genuine medic from HEMS that I saw smiling up at us.

The HEMS team carried on where we left off and I put a line in for fluids. All the while, the man lay there, quietly shaking his head from side to side as if to say ‘what an idiot I’ve been’. He never once cried out or complained or gave us any trouble whatsoever. I wish all my trauma patients were like that. His obs were stable but he was, understandably, very pale. His leg had been torn away from the upper part of his shin, just below the knee, to just above the ankle joint. Most of his muscle was gone. He would need extensive reconstructive surgery and he’ll know pain and immobility for some time, I suspect.

He had been standing near the bus when it was pulling into a stop when his jacket somehow got caught in the doors (this is the second such case I know where bendy buses have caught someone like this). He was dragged to the ground and his legs were pulled under the bus. The rear wheel went over one of his legs as he tried to pull free but it must have gripped at the fleshy part, rather than roll over the bone, thus no fracture (that we could determine). This caused massive tissue damage, however, and that will take a lot longer to heal than if he’d just snapped his leg.

My next call, once I’d cleaned up, was for a hysterical 19 year-old who was very drunk, very loud and insisted on thrashing about on the pavement. She had other issues besides being drunk and stupid, I was sure of that. She’ d slump into silence while her friends and boyfriend stood over her, wringing their hands about how ‘ill’ she might be. I told them she wasn’t ill. I told her she was behaving like a baby. She had already clubbed me a few times around the head and legs with her over-active fists and feet and I’d shouted at least once that she best behave herself. It took another ten minutes to get her to stop assaulting me.

Eventually, after I’d cancelled the ambulance for this fraudster of a ‘patient’. She went quiet again and seemed to settle into exhaustion. Minutes earlier, I’d been treating a man who was lucky to have kept his leg after his encounter and now I was kneeling over a large, emotional wreck. Instead of baby-sitting her on behalf and at the expense of the tax payer, I suggested they all go home by taxi. Her boyfriend would be with her all night, so if she suddenly ‘deteriorated’, he could call us again. She didn’t want to go to hospital anyway; she was an obdurate child in a teenager’s body and I had no time for her.

As they dragged her to the taxi, I asked her surname. The boyfriend turned round and gave me a blank look.

‘Oh, I’m not sure actually’.

True love.

A call for a 44 year-old man who was hypothermic and had chest pain (that sounded alarm bells – it was probably a rough sleeper trying to get a bed for the night) had me searching the location for my patient. A drunken man approached the car and told me his mate, the ‘patient’, had stormed off after waiting five minutes for me to arrive.

‘He’s pi**ed off that you didn’t come for him, so he’s gone. I’m f**king annoyed at him!’ he spat into the car. They always lean right in, no matter how much your hand tells them not to. His breath was like the breeze from a rubbish dump.

I thanked him for his valuable information and set off on my last intrepid adventure in ambulance land. It was for a 26 year-old male who’d been found lying on the kerb, bleeding from his head. He’d probably fallen down drunk and cracked it open, or he’d been assaulted by someone (again most likely drunk) and left there. Whatever it was, I never found out because the crew were on scene and dealing with it. I wasn’t required and I set off back to my base station and crossed my fingers that the phone wouldn’t go until I had ended my shift. The minute hand of the clock crawls when I wait like this.

I got off on time and went home to sleep in preparation for yet another night of drama and stupidity.

Be safe.

Friday, 28 March 2008

For the record

Five emergency calls; one pronounced dead on scene, one cancelled on scene, the others by ambulance.

A 40 year-old man with a history of recent kidney replacement collapsed in the street. He had low blood pressure and looked quite pale but there was no pain associated with his current condition. An ambulance took him to hospital where his renal function will be investigated no doubt.

Then a 49 year-old man with a history of cardiac problems collapsed after feeling dizzy. He also had a headache and he too, looked pale when I arrived. The crew were right behind me, so I handed over to them and accompanied them out to the ambulance, where I intended to look at the ECG before leaving the scene. This plan was thwarted, however, by a General Broadcast (GB) overheard on the radio by one of the crew. A cardiac arrest nearby had been waiting for an available responder and, as the man looked stable enough and the crew didn’t require my help, I felt I should free myself up for it.

I went to the car and ‘greened’ up, then called Control and notified them that I was available for the suspended call they had just GB’d. I was sent the details and off I went.

I arrived outside a psychiatric hospital and the crew pulled up within a few seconds of me. I asked them to go up and start working on the patient while I got my equipment together and greeted the MRU paramedic who had been sent to assist. We followed the crew to the little room in which a 35 year-old female lay on the bed, obviously dead. Although CPR was being carried out by the crew, there was post mortem staining on one side of the body and that side was cold to touch. The ECG showed consistent asystole and a doctor was on scene. We had everything we needed to call this one and, after a few minutes, we did, with the full agreement of all present, including the doctor.

The woman was known to drink and take overdoses of pills. It looked like she was successful this time, if that’s what killed her. The Coroner will decide in this case. All we had left to do was tidy up and complete paperwork. I left the crew to do that and went to my next call, a 65 year-old male who had fainted at home but as I pulled up and the crew arrived, I was recalled to the last scene to complete a PLE form (this is used when we pronounce life extinct). I had thought the crew could do that but apparently (and I’m not the only paramedic who didn’t know this) the clinical lead (i.e. the first paramedic on scene) is supposed to do it. So there I was, completing the very form that the crew had already completed before me. It seemed silly, really.

I was also asked to attend my home station for a police interview in which I had to give a statement regarding the young man who was stabbed to death near Trafalgar Square. I posted on this a few weeks ago. Apparently a witness to the existence of a stab wound was required because HEMS had obliterated it when they carried out a thoracotomy in order to gain access to the man’s heart. I was sure that I wasn’t the only one who’d seen the wound but I was the only one they could get a hold of. The whole statement process took more than an hour. It’s the second I’ve given in as many weeks.

I ended my shift with a 52 year-old man who was having a severe asthma attack; a proper one, not one of those calls we get because someone is a bit wheezy. This man was in dire trouble.

I nebulised him once I got past the large but friendly dog (one of two – the other was small) in the hallway. The family were deeply concerned about him because he had never been so bad and his inhaler had failed to help. He was using every accessory muscle in his body to breathe and sweat was pouring off him. I’m supposed to record a peak flow reading but, as in all of these serious cases, I didn’t – it was more important to get him breathing properly again. I would record this on my PRF and hope that it was accepted.

By the time the crew arrived and took him to the ambulance (which was only five minutes), he was breathing better and looked like a different man. He was given further doses of Salbutamol and Atrovent on the way to hospital - he was ‘blued’ in.

That job made my day worthwhile because I felt I did something useful for a change.

Be safe.


Five emergency calls – all by ambulance.

More snow today, the last of it I think. I’m looking forward to sunnier days ahead.

Only one of the calls I attended today required an ambulance and even that was for self-abuse.

I covered pregnancy in my book and it still amazes me that an emergency response is expected when a nine month process is coming to an end. I can understand it when there is no warning and the baby decides to start its descent with minutes to spare, or when there is a genuine emergency, or the mother is on her own and has no experience of childbirth. What I find annoying is that we are frequently used like a taxi service by women whose waters may or may not have broken, whose contractions are often miles apart and who have waited long enough to have made their own way to hospital.

A 31 year-old pregnant woman, in her 41st week, sat on her bed for hours after her waters broke. Her contractions were 3 minutes apart when I arrived but she had plenty of time to get a taxi or have someone drive her to hospital. Instead, she waited until almost the last possible minute and then got her husband to dial 999. Now she had the urge to push. So did I.

Pain is difficult to assess but it’s not difficult to see on someone’s face. That’s why I didn’t believe the 42 year-old man who claimed he had severe chest pain (and DIB of course) at a train station. Staff had taken him into the office and he was sitting waiting for us to turn up before continuing his charade. I didn’t recognise him but I could tell (as could the crew and the MRU paramedic, who was on scene first) that he was living rough. He may well have been suffering some kind of pain but his face showed absolutely no expression for it. Even the member of staff who led me to him said he suspected the man was play-acting.

Drug addiction is also draining us of money and resources and it’s about time we threatened sanctions and removed benefits from those who continually abuse the system. I know there’s a great argument about how they will fund their habit if they don’t get money (i.e. more crime) but why should hard working tax payers finance the cost of their drugs and the consequences of their abuse? A single drug addict can find himself in hospital dozens, perhaps even hundreds of times in his lifetime. Have we any idea of just how much that person is costing us?

A two-for-one call next to a street where all of the houses are hostels. The complex attracts a lot of police and ambulance visits and this time I was going to see another pregnant woman but I had been told to be cautious because there was a known violent person at the scene. I asked for police to attend and when I arrived I was greeted by the hostel workers.

‘Are you here for the pregnant lady or the unconscious drug addict?’ one of them asked as I pulled up.

‘What do you mean? I only know of the pregnant woman’, I replied.

Apparently there were two separate problems here but we only knew of one, so I called it in and requested another ambulance. The ambulance meant for my patient arrived as I explained that the pregnant woman would have to wait, so I asked the crew to attend to the unconscious man, whom I’d yet to see, whilst I dealt with the lady.

The 29 year-old was waiting for me, bags packed and ready to go. She had been having contractions since the night before and now she wanted to be taken by ambulance. Across the street, a real emergency was demanding our attention and this, I think, highlights my point in a very tidy way. Now she had to wait for another vehicle to arrive and when it did the crew were obliged to see if the first crew required assistance while I walked this healthy young woman down to the waiting ambulance. A colleague stayed with her while I went to see what could be done in the other building.

A man lay flat on his back, unconscious and overdosed on Heroin. The crews were working around him, trying to keep him breathing until he could be recovered using Narcan. I asked the second crew if they could take my pregnant lady to hospital and that left me with the first crew, the police (who’d arrived soon after the first crew) the hostel workers and the unconscious man. Ironically, he turned out to be the very person that I’d been warned about approaching; he is known to be violent to ambulance crews. I can see why he doesn’t favour us – his fix was about to be taken away from him.

When the Narcan finally took effect (after a long twenty minutes and several doses) the man became rousable, then noisy, then aggressive. He struggled so much that it took three of us to pin him down. He was fairly big and the prospect of carrying him down the narrow stairs while he did his large dying fish impression didn’t inspire any of us, so the police trussed him up; ankles, knees, arms. He was handcuffed behind his back too, so now he couldn’t struggle. We had to be careful not to hurt him, however, and no matter how over-the-top his containment might have seemed to the waiting onlookers outside, it was important to keep him still for his own good...and ours of course.

Off he went to hospital, where he ended up on the bare floor of a cubicle, still trussed like a suckling pig until he was calm enough to behave. So far, he was the only patient who needed to go to hospital by ambulance.

Frequent flyers are a cause for concern and our society tolerates them because we don’t know what else to do with them. There’s a real need for a back-to-basics approach with family structure and social cohesion so that people learn to fend for themselves but we live in a nanny state in which a blame culture exists, so weaker individuals use that to run up huge bills at our expense; it doesn’t matter to them because they aren’t having to go out and earn a penny of it.

Finally, just to salt my wound for the time we are wasting, a 41 year-old frequent flyer (the same guy that walked off on us after we found him across the road from the hospital, having dialled 999 for an ambulance to take him there a few months ago). Again, he was claiming chest pain and DIB and again he had no such thing...really, he didn’t. The man has deep social issues and I’ve known him for more than 3 years; he goes to hospital and they check him out before feeding him and letting him go again. The crew were as gentle as lambs with him and even I didn’t have the heart to chastise him this time round; on busier days I usually don’t have as much patience for him, although one day I know he will genuinely need us and that may be his downfall.

Be safe.

Thursday, 27 March 2008

Time to think

Five emergencies; one assisted-only, one declined and the others required an ambulance.

Still snowing. The threat of it lying on the ground has been lessened by the mixture of sleet and rain we’ve had today, so I shouldn’t be skidding around the roads. We’ve been issued with special covers for our wheels so that we have a bit more traction in snow and ice – they look like condoms for tyres.

An 83 year-old female with chest pain was known to the crew when they arrived after I had started my obs. She’s lonely and needed sympathy but she also had an irregular heart beat and that warranted taking her to hospital where she will get all the attention she needs, if only for a few hours,

A 45 year-old man who was ‘unrousable’ on a bus and so the driver called us out to remove him, one way or the other. The usual way is to wake them up and walk them off with a few polite words and that’s all I had to do. The man was face down in the aisle between the seats and his tell-tale can of extra strength lager was nearby. I shook him and shouted into his ear so that he wouldn’t mistake me for the driver (he wouldn’t care at all if he knew it was him; these guys know the drivers can do nothing to them). He woke up and, somewhat groggily, began to recover himself and sit up.

‘Do you need an ambulance?’ I asked in the well-rehearsed and customary manner.

‘No’, he replied in the equally customary and completely expected fashion.

‘Thanks for your help’, he went on to say. Now that surprised me; it doesn’t happen much on the buses.

I walked him carefully to the exit and the bus driver decided to storm up to him and scowl. Until now, he had kept his distance while I got on with it (I don’t usually say much to the drivers – I just get on, wake them up, say bye and go).

This little face to face encounter annoyed the drunken man and he postured aggressively. Great, this was all I needed; he had been a lamb with me and now he’s getting ready for a fight because the driver has suddenly got all brave.

‘Okay, let’s go. Don’t worry about it’, I said to the man while simultaneously throwing a ‘back off’ look at the driver, who promptly turned on his heels and stamped down to the other end of his bendy bus.

As soon as we were clear of the doors they closed and the bus drove off, almost as if the vehicle itself was in a huff with me.

I looked at the man and he reminded me of someone. I said cheerio and he left after insisting on hugging me and polluting my uniform with the smell of fags and old booze (among other things).

When the crew turned up they caught sight of him as he walked off and I signalled that there was nothing to do here. That’s when my colleague jogged my memory of who he resembled; Eddie Murphy in Trading Places. The sleeping drunk dressed just as the actor had when he played the part of the legless beggar in the park. This time, the only relevance I could draw to the lookalike being ‘legless’ was in terms of his drinking habit.

My next call was to attend a 65 year-old male who had fallen at an underground station and sustained a head injury. Sometimes these falls produce dangerous injuries, so I hurried along to the scene and was led to the gentleman, an Italian tourist and his son, who were sitting in the station office, neither looking much the worse for wear. It was explained to me that the man had initially been dizzy after his spill but he had no injuries and he translated through his son that he had no interest in making a fuss.

I checked his obs and the crew did the same but we had no choice but to pronounce him fit and well. He declined the offer to go to hospital, just as any sensible adult who knows his own body would and we left them to get on with their day at the theatre.

Speaking of which, yet another collapse at a theatre – what are they putting in the water? This time an 81 year-old man had become very dizzy and faint whilst watching the show. Now he was out in the foyer, where a breeze (ice cold) was making him feel better. He went into some detail when asked about his medical history and I was an expert on his reflux problems (he has oesophageal stenosis) by the time the crew arrived. He belched a LOT during the conversation and that can sometimes suggest a cardiac problem but I honestly think he was suffering from gastric reflux (mainly gas). Whether this had any connection to his dizziness, I didn’t know but he seemed fine when he was taken to the ambulance. In fact, he seemed to welcome the trip. I shall be keeping an eye out for him in the future; I expect I’ll see him again.

My second encounter with a bradycardia requiring Atropine treatment occurred at a tourist attraction in north London. A 55 year-old man had collapsed and passed out in front of his young grandson and several witnesses. By the time I arrived he had recovered enough to be taken by wheelchair to the exit for fresh air. I examined him and found his BP and pulse to be very low; his pulse never climbed above 40 bpm. He was pale and still not fully recovered, even though he was lucid enough. He had a history of high blood pressure and was taking antihypertensives for it – he hadn’t missed any nor taken too many today, so his condition was a mystery, although I suspected we’d find a block on the ECG.

The crew took him to the ambulance and I assisted the paramedic with the man’s treatment. Atropine was administered and his pulse rate improved, as did his BP. I didn’t see it get as high as I would have liked – around 60 bpm but it had increased in rate sufficiently enough to suggest a recovery. His ECG looked normal but there were a few anomalies and neither of us could translate them – they would need to be interpreted by a cardiac specialist at hospital.

My calls were spaced out over the shift today and I got plenty of time to reflect on the last few weeks and the incredibly precarious position that paramedics can find themselves in without warning. I’ve spent my entire career avoiding issues which might lead to disciplinary action and possibly being struck off the professional register; it has happened to many paramedics and some of them have been punished simply because they were seen as the ‘clinical lead’, regardless of who else did the wrong thing at the time. Taking and holding that lead can be difficult within a culture that is yet to fully understand the changes the pre-hospital care sector has undergone. It’s not about ego or arrogance; it’s about completing a task that you started and being held accountable for the outcome – I think I’d rather make a few enemies by standing my ground than be struck off and end my career in shame because I relented when I shouldn’t have. I’ve been taught a sound lesson on a few calls recently and like all of my colleagues who must have experienced the same, such incidences put you back where you belong – in charge of yourself.

Be safe.

Wednesday, 26 March 2008

Lethal weather

Eight emergencies; one assisted-only, seven by ambulance.

The cold, snowy weather reminds me that our climate has probably changed for good. This is the time of year when tourists usually enjoy the first sunny spells in London but those days seem to be gone, or at least are becoming rarer. I’d like to think we were doing our part to reduce the carbon footprint but we will, as always, be out and about in our diesel vehicles, running up the debt for the sake of the sick (and more often the not-so-sick).

First off, a 75 year-old with SOB, especially when moving about. She has recently had her Aortic valve replaced and was fine for a few weeks but now she feels lethargic and can’t get a breath. All her obs were normal, including her sats, so there was nothing screaming out. Her BM was a little high but that can happen in times of stress. Nevertheless, given the recent medical history and her present complaint it was prudent to have her taken to hospital on oxygen.

Next, a 25 year-old man complaining of chest pain. He worked at a hotel and I found him in the basement office. He made no eye contact with me or the crew when they arrived and throughout the entire examination he mumbled his answers to my questions. He seemed evasive…or maybe that was just him. Whatever it was, my gut instinct was to think he was lying about his condition. I go to a lot of hotels where foreign staff feign illnesses to get off work, I think it may be because they feel (or maybe it’s true) that they will lose their jobs if they don’t show up.

Tachycardia in young people is fairly common and can often mean nothing at all and so when I was called to a 22 year-old with a history of undiagnosed periodic fast heart rate, I had to reassure her. She had been scared by the last event she experienced, when she was told that her HR was so high that her heart might fail. She was waiting in a reception area at work with a heart beat of 250 per minute. Of course, being told by a medical person that you might die if it goes on for too long will only exacerbate the condition, causing an increase in rate to the point where, well, yes…you could die. So, in these cases, reassurance and confidence is required, not scaremongering.

The crew carried on the work of calming her and by the time she was in the back of the ambulance, her resting heart rate had dropped to almost normal. No drugs, no manoeuvres, just quiet chatting and continual reassurance.

She was taken to hospital because her condition needed to be checked again. Regardless of how common this might be, without aetiology, there are always cases that throw up cardiac defects when looked at closely enough.

After a short break and during a period in which the weather worsened, I was sent to check on a 3 year-old girl with severe DIB, a high temperature, tachycardia and who was vomiting. The call description also included the words ‘eyes rolling’, so the whole thing sounded like a febrile convulsion, with the addition of a few extras, which may or may not have been the result of panicky parents.

However, when I arrived I immediately recognised the little girl and her mother. She has a suspected congenital condition, which is yet to be identified, giving rise to these signs and symptoms. She often goes into respiratory arrest as a result and this means that she requires emergency (blue light) transport to hospital whenever the condition affects her like this. This was the second time I had encountered her; the last time was at her aunt’s address, so I was initially confused by the presence of a pulse oximeter in the room and a very knowledgeable mum, who could explain in technical terms exactly what was going on. Only when I looked at them and thought for a second did it dawn on me.

The crew arrived within a few minutes and I explained that we needed to get this patient to hospital fast. None of us wanted to be holding a young child as she stopped breathing. The last time I met her, she was very lethargic and wanted to go to sleep – this time, thankfully, she was more alert.

‘Hello’, I said, ‘do you remember me?’

‘Yes’, she says, nodding her head. She’s not in the mood for smiling.

‘Are you getting fed up of this?’


Of course she is. She’s in and out of hospital with this frequently and every time her mother gets to the Resus room with her, she has to explain, all over again to a new doctor, what the problem is. It must be exhausting for them both. I left the little girl sitting on the bed being poked and prodded by the medics. She looked annoyed with them.

A 23 year-old who was ‘not alert’, greeted me with an embarrassed smile as she lay on the floor of her workplace at the behest of the first aider, who had called us because she was genuinely worried. The Croatian patient didn’t want an ambulance called as she was having a heavy period and had felt a bit faint as a result, that’s all. She could deal with it on her own. The appearance of the ambulance crew made her want to shrink into a corner. Croatians, from my limited experience of them from visiting their country and seeing their healthcare system at work, don’t tend to call ambulances for minor problems. They come from a generation of people who were sniped and killed during the Balkans War, just for crossing the street.

She declined our offer to take her to hospital if that’s what she wished and, after a check-up in the ambulance, went home to rest it off.

Then my day turned sour. The wind was blowing hard in gusts of 40mph and the weather was generally wintery – a miserable combination for a call outside for a 23 year-old female who had been hit by scaffolding. At first the call described a head injury, then the details changed and now she was unconscious. I was asked to report for HEMS on arrival, which means the job may be serious enough to warrant the helicopter, although I doubted it would fly in this atrocious weather. There was a doctor on scene apparently but I had to assume it was an off-duty GP because he didn’t give much in the way of details.

As I drove to the scene, an update informed me that the girl had been hit by heavy boarding (the type used to screen off building sites) and she was bleeding from the head and nose. This was not good and I requested the assistance of the Fire Service when a further update informed me that she was buried under rubble. What the hell was going on?

I arrived to find an ambulance crew on scene and one of them shouted that I needed my bag. A crew will only do that if things are serious. I confirmed that HEMS was needed and radio’d in before grabbing my bag and running over to where an MRU technician was kneeling over the patient. She may have been covered in the material that had blown down at some point but now it was strewn around her. At first I thought she was a he because her hair was matted in blood, making it look short and boyish.

Her boyfriend was there and he stood among us as we worked on her. He was pale and stricken; you could read the shock on his face.

His girlfriend was in and out of consciousness and had blood pouring from her ears and nose. She had skull fractures for sure and I learned that the large board had been ripped from its frame by the wind as she and a group of friends walked past. She was the only one to be hit and she took the full force of the thing on her head. It was clear from the heavy, nail-spiked wooden debris around that her injuries would be very serious.

I could hear the familiar clatter of the helicopter above us; they must have been despatched earlier and I couldn’t believe they were going to land that machine in this wind…but they did and the pilot has my highest admiration for it. They set down neatly on a small mound of grass between a bus station and the scene. They can land on a penny if they want, I think.

A quick examination was carried out following my secondary survey and the girl was rapidly moved because her condition was getting worse. She was scooped up and taken into the back of the ambulance. The HEMS team piled in with her. My role ended there, as it did for my MRU colleague.

There were now a number of ambulance personnel on scene, including the HART team, who’d been called out because of the nature of the accident. The Fire Service were there too and a few ambulance officers turned up later.

As we stood outside the ambulance, the LFB (London Fire Brigade) began the task of dismantling the remaining boards to make the area safe. A main road ran directly in front of the scene, so any further flying structures could cause more trouble. Out of the corner of my eye I caught a glimpse of something big and black flying towards me and a few of the others who were milling about. Another board had come off and it flew at speed across the pavement at head height, smashing with some force into one of the fire trucks. It caused a bit of commotion because we now realised just how dangerous things were for us. I looked up and saw a Fireman standing on the frame with a claw tool in his hand. He looked shaken and very sheepish. He had been loosening the board when the wind caught it and took it from him.

The girl’s boyfriend had been a few feet away from the flying panel and it would have been a horrible irony if he too had been injured.

When I looked into the ambulance, just before I left the scene, I saw that the girl was being put to sleep. I heard later that she had become combative and that she had deteriorated so much that the only safe way to deal with her was to carry out an RSI.

I went back to my station to recover from that call but I didn’t get much time to think. I was off again for a 4 year-old who had fallen and had a head injury with ‘serious bleeding’. In fact, when I got there the child was standing in a bath with a wet towel on his head, courtesy of his father. The bleeding was never serious and the injury amounted to nothing more than a scalp wound. The family obviously lacked the experience to understand the difference.

My shift ended with a second major call. A 30 year-old male had collapsed and was now unconscious and bleeding from his nose. This wasn’t weather related but it was still unusual. He had fallen outside a pub and I was expecting to find a frequent flyer drunk on the pavement. Instead I found a small crowd of people tending to a man who was out cold after collapsing suddenly and crashing head-long into a tree. He had a massively swollen eye as a result of his encounter but, as he had collapsed before the trauma, I knew there was more to this.

His girlfriend was with him and she explained that he had high blood pressure but nothing else wrong with him. She hadn’t seen him fall because she was walking slightly ahead of him but plenty of other witnesses confirmed that he just fell suddenly – no trip, no sound.

The guy was older than given – he was 52 years-old and his pulse was very slow; around 32 bpm when I looked at it. I checked again and again as I put oxygen on him and he began to stir but it remained low. A drop in pulse rate will often be accompanied by a drop in BP, which results in collapse. The problem was his pulse wasn’t improving, so something could be wrong with the conduction system of his heart. He hadn’t complained of chest pain prior to falling and he had no history of MI.

The crew arrived and we quickly got him into the ambulance. His ECG clearly showed third degree heart block; his pulse remained extremely slow and his BP was dropping by the minute – dropping into his boots, as we say. He couldn’t survive this if it was allowed to continue, so my colleague raised his legs and set up fluids to bolster his circulatory system but that wouldn’t be enough. He needed something to speed up his heart rate, so that everything else normalised and he became stable. Atropine is the answer.

I drew up a small amount of the drug and administered it slowly. The technical bit now; the block was causing two separate impulses to work his heart at different rates – the normal atrial contractions were continuing but the ventricular contractions, the ones required for circulating blood and therefore systemic blood pressure, were firing off at a slower rate from somewhere else in his heart – probably way down in what’s known as the Bundle of His or even the Purkinje Fibres. His QRS complexes were not too wide, so he could be getting his ventricular impulses from high up in the fibres. Atropine would affect this and take the brakes off his heart, allowing it to increase in rate, pumping more blood around and normalising his system until something definitive, like transcutaneous pacing, was carried out.

Too much of the drug could be detrimental. Not enough of the stuff could also be detrimental. I needed the right dose, so he got 0.4mg and that was enough. By the time he got to Resus, his condition had improved significantly.

I learned a lot from that call but my feeling of satisfaction with a job well done was tainted by the earlier call for the girl who had been hit by that huge board. Sadly, I was to learn from a colleague later on that her condition is so serious (she has multiple skull fractures) that her prognosis is poor. She is unlikely to survive.

Be safe.

Tuesday, 25 March 2008

On the truck

Every fifth week of my five-week rota, I am given two days of ambulance work. That is, in order to keep my skills up, I crew up for two days on a proper ambulance. All of the FRU pilots have to do this now but, personally, I feel no benefit from it.

For example, the last two days that I did recently comprised one day on an ambulance that was impossible to find at first because all the vehicles were being used, so I had to ‘create’ one from a shell (an empty vehicle). I transferred equipment from one old bus to the other in order to get me and my crew mate on the road and in commission. No sooner had we started, however, than we hit problems.

We got one emergency call for a simple scalp injury and the sirens packed up on the way there. I had to suggest through blue lights and sign language that the cars and trucks and buses in my way should allow me through. Luckily, it wasn’t a life or death situation and the vehicle was taken off the road immediately after we delivered the man to hospital. Embarrassingly, as we set off, the back doors decided not to work and I couldn’t shut them. My crew mate had to manipulate them from the inside. Mr Brown, please can we have some more money for workable ambulances?

That was it for my first shift. I was single soon after that and had nowhere to go.

The next day I was back on a FRU (and this is usually the case when they can’t get me crewed up on these days) but there were plenty of other FRU’s around and so I did one job again all shift. I’m not complaining; the rest was good and I got to do some studying and other stuff.

The call was to a 33 year-old man who was vomiting blood in a public toilet at a train station. The crew were there with me but we couldn’t find him, so we searched around until I spotted the loos across the road. I walked in to the Gents and called out for an answer from the only cubicle that was occupied.

‘Did you call an ambulance?’

‘Yes’ came the muffled reply.

He took forever opening the door and by that time, the crew were in the toilet too, one of them is female, so the bloke who walked in to pee made sure his back was wider for the occasion.

I remember a call I attended years ago in Soho, where a guy was throwing up and in a collapsed state in the Gent’s toilet of a club. I walked in to find a female paramedic dealing with him in the cubicle and a long line of men standing at a wall of urinals, looking in her direction. Some of them were smiling. If it was moral, or legal, the photograph would have been priceless.

End of digression. That was my day. No more jobs came my way after that and I got another peaceful shift. In that respect, I’m glad of the change from FRU to ambulance detail. I may be tempting fate just recording it.

Be safe.

Monday, 24 March 2008

A blistering case

Eight emergency calls; one assisted-only, one no trace and six by ambulance.

A 19 year-old gay man was left lying on the cold, wet pavement of a busy Soho street by his ‘friends’ because he was so drunk they couldn’t cope with him any more. He had been there for an hour before anyone stopped to ask if he was okay. Barely dressed and freezing in a foetal position, I had to cover him with my jacket to keep him warm whilst I waited for an ambulance. He was very apologetic and ashamed of his condition and I felt a pang of sympathy for him, even though his circumstance was brought on by his excessive alcoholic binge, his friends should never have abandoned him in such a potentially dangerous area – shame on them.

The rain was falling very hard tonight and this puts all of us in a less than light mood when we have to struggle with wet, drunken people in public places. So, when a 35 year-old Polish man balled his fist and threw a punch at me, I pinned him to the bus shelter he was leaning against until he relented. His face dropped because he thought he was going to land one on me for free, courtesy of the NHS. He was wrong and although I kept him restrained, I caused no harm to him.

Eventually he became a friend to all of us; me, the MRU technician who was on scene when I arrived and the crew when they turned up. This was mainly because one of my colleagues – the multi-lingual paramedic – conversed with him immediately in his Communist-era tongue (Russian). He was happy now – no more BS from foreigners!

That particular drunken Pole was left to sleep at the bus stop shelter – he declined to go to hospital, which was probably just as well for our definitive care colleagues.

I arrived at a betting shop next. The rain was unrelenting and I stepped out into the morass of litter and puddles to help a 65 year-old man who had ‘drunk too much’ and ‘can’t get up’. Oh and just to make sure we arrived, he told the staff he had chest pain, which he denied when I got there.

His soaking, sleeping figure was slumped on one of the tables laid out for the punters and I had to shake him a lot to get him to open his eyes and talk to me. He was Scottish and homeless…and very drunk on cheap booze. He just wanted to get out of the rain and since he knew that, inevitably, he would be exorcised from the betting shop, he decided on plan B – call an ambulance. Again, I sympathised with his plight; it was a horrendous night and it wouldn’t be fair to chuck him out into it, so when the crew arrived, provided he behaved, he was promised a trip to hospital. He was cold and too drunk to walk properly…or so he said. We believed him but he almost sprinted to the ambulance. My colleague had to tell him to slow down. I was reminded of a lazy dog that drags along on the leash until he sees a park. Or another dog. Or food.

A 40 year-old woman with a history of faints required my attention when she passed out in a theatre (people do that a lot). She is taking meds for hypertension, so it could have been her pills that brought about a crash in her BP, thus the faint but it’s better to be safe and so she was taken to hospital for further checks.

A strange call next for a 50 year-old man claiming to have chest pain, shoulder pain and DIB…oh, and spots on his back. This combination made me suspicious, so I went to the little flat and entered at the behest of a child with some doubt and a defib at hand. He was flopped over his sofa and looked to be in some discomfort, unlikely to be the fault of a dodgy heart. On his back there was a hand sized cluster of blisters; I thought he had been deliberately burned because they were fresh. He shouted something at his wife, who was shy to appear at first and she shouted something back – none of it in English. In fact I had to rely on the commentary of one of their daughters, a ten year-old, to begin to understand what was happening here.

Nobody could explain the blisters – they had just appeared apparently and he had associated shoulder pain. Then he showed me more on his chest which had just erupted. I had never seen anything like it. I was initially stumped with this one and I called Control for advice. I couldn’t be sure I wasn’t looking at a contagious disease or a chemical contact, so I needed to be very cautious about moving him or exposing anyone else to whatever it was.

I described what was going on to the HEMS team and they consulted a doctor who came back with a ‘it’s probably not contagious, whatever it is’ answer and that just wasn’t good enough. I instructed the family to wash their hands in case any of them had touched these, now spreading, blisters and they went away to scrub up. I felt foolish because something was niggling at me and I couldn’t put my finger on it. The eruptions reminded me of something.

The man worked with chemicals for cleaning, so I had to assume there might be a connection but then he explained that he only worked with lemon juice products, not seriously caustic stuff. That ruled that theory out then.

Then I had an inspiration. While I waited for an ambulance I took a close look again and realised that what I was remembering was a case of adult chickenpox.

‘Have you ever had Chickenpox?’, I asked.

‘No’, he said.

‘Has anyone in the family ever had it?’


‘Are you absolutely sure?’


The crew had been sitting outside for about ten minutes but I didn’t know that until I got the call back detailing the doctor’s advice. They had been told to stay put until given the all-clear because there was possibly an infectious disease or chemical substance involved. If there was I was well and truly stuffed, wasn’t I?

I took him and his family downstairs and into the ambulance. The crew had never seen anything like it either and the rash of painful looking blisters continued to form and spread in front of our eyes. When we got to hospital the nurse asked the man a single question and my earlier instinct caused a click in my head (that should be a light bulb but I don’t deserve one of those on this call).

‘Have you ever had Shingles?’, she asked.

‘No’, he said, as usual.

Now I know that you can't get Shingles unless you have already contracted the Chickenpox virus, Varicella Zoster. The man had already vehemently denied having this disease, even in youth, so it wouldn’t be possible for him to have this complaint but it all made sense: painful erupting blisters on one side of the body only (his were back and front on the right side), with associated pain from the affected nerve bundle. If the Zoster virus was active in his shoulder nerve, the Shingles would manifest in precisely those areas I think.

I never found out for sure what this man had but I was right to get the family to clean their hands; the blisters carry the virus and so can be contagious if touched. Maybe not a big deal for the kids, who should be exposed to it as soon as possible but it can be dangerous for an adult and his wife said that she’d never had it. This was an interesting call that made me feel inadequate and smart at the same time. I’ve never seen Shingles, so I think my reaction to this initial sighting, if that’s what it was, was justified.

If your relative faints, don’t carry her out to me as I arrive. A whole Chinese family were piggy-backing her out the door when I pulled up (again in the pouring rain). I had to ask them to put her back where they had found her. They turned on their heels and dropped her onto the hallway floor in a very smelly part of the building.

The 35 year-old wasn’t unconscious; she was trying to be. All her obs were normal but she had abdominal pain. She ‘passed out’ again as I completed my checks. Getting the story was a nightmare because I had to go through two different translations but it soon became clear that she may have been pregnant and had now miscarried. The crew arrived at that conclusion when I handed over because, although I had established her last menstrual period was recently, they found out that she hadn’t had one for 50 days before that.

A fast drive from south London to the north for a RTC in which a bus had hit someone, causing an eye injury next. Unfortunately, the facts were shady and the caller stated that he had seen all this ‘from a distance’. When we got on scene there was no trace of this alleged victim. The police were there and a crew had completed an area search; it was a long drive for nothing again.

At just about going home time, I went to a block of flats for a 25 year-old female with a PV bleed, abdo pain and back pain. She was 35 weeks pregnant and had evacuated ‘pink water’ when she urinated. It was unlikely to be anything serious and the crew were right behind me, so I made my way out and towards the sparkly lights of sleepland. You know where that is, don’t you?

Be safe.

Sunday, 23 March 2008

Losing babies

Eight calls and one running call – two conveyed by me, one no trace/hoax, one false alarm, one assisted-only and three required an ambulance.

I’ve posted about miscarriage many times and my first call, to a hotel in south London, reminded me of the emotional impact such a devastating event has on a couple. The 33 year-old was distraught because this wasn’t her first failed pregnancy. This time it had gone further than before but it looked like all was lost again. She had lower abdominal pain (cramping), heavy PV bleed with clots and a history to back it up. Her husband could do nothing more than hold her as she sobbed in the back of my car. I decided to take them to hospital myself; they had walked out to me and I could see in her distress that the last thing she needed was more fuss than she already had.

A call to a night club and restaurant in the West End for a 42 year-old female who was having an allergic reaction to oysters turned out to be a faint by all accounts. My colleague was on scene just ahead of me but I managed to get the gist of the story and there were certainly no tell-tale signs of allergy. That didn’t stop her arrogant friend from telling the paramedic that he was wrong and that she was definitely reacting to the oysters she had eaten. Her tone was very patronising and it’s something I can’t abide because I don’t see us as merely servants to the whim of the public.

‘Are you medically qualified to make that diagnosis madam?’ I asked politely.

‘Well, no’, she replied.

‘Then can I suggest you let my colleague carry on with his checks and reach a conclusion based on them?’

I too must have sounded arrogant but I didn’t mean to; I could see this lady bullying her opinion onto the PRF and that wasn’t right.

A 30 year-old male fitting outside a pub carries the high probability of my finding a drunk on the ground but this time it was an emotional young man with mental health problems. He was reluctant to have the crew help him in any way and was a little aggressive with me to start but the shocker for me was finding out that the very drunken guy who kept butting in to ‘help’ was the manager of the pub I was outside. He may have been off duty but he was still a bad advertisement for the place as he was more sozzled than his customers. Are you allowed to be that drunk in charge of a pub? Surely you still have a duty of care whilst on the premises? If you are a publican, let me know, I’m curious and too lazy to look up the licensing act.

The patient had left his coat and bag somewhere and I went to look for it while the crew settled him down but it was nowhere to be seen.

‘Don’t worry’, slurred the super-sloshed manager, ‘if we find them we’ll take care of them for him.’

Admirable but not what was right.

‘No, can you find out if anyone on your staff has seen these items?’, I asked.

He wobbled a bit and I decided to do the job myself. I went into the bar and asked if the man’s belongings were in there. Immediately, the barman pointed to the floor and there they were. They soon joined their rightful owner before he became upset again.

A drunken Australian was found collapsed outside on the pavement by a bus driver and I arrived to find him being guarded by the aforementioned good citizen. I thanked him and got on with the job of waking my charge up. He had vomited a few times and was clearly too drunk for his own good. I always find Aussies honest and generally good-natured about their inebriation. It’s almost a hobby to some of them, although they would never dare use the term ‘alcoholic’.

‘Can’t you just leave me here to sleep it off, mate?’ he asked after I told him he would be going to hospital. He was almost ashamed of that and preferred to lay there in the middle of a public place until the morning. By that time, of course, he may have choked on his own vomit or died of hypothermia, so strictly speaking, much as I admired his courage and respected his Antipodean way of thinking, my duty was to see that neither happened. He was going to hospital.

As usual with all my patients from the land of the big red hill, he was a thoroughly likeable bloke.

Then I got to drive around Euston with an ambulance and the police in tow trying to find an invisible man who’d allegedly been beaten up and left for dead in the street. Nobody saw him and the caller couldn’t be contacted again. Funny that.

A lonely 53 year-old woman who just happens to live very near to our main ambulance station had me fixing her home nebuliser, just so she could have company for twenty minutes. She had called claiming an asthma attack but that simply wasn’t the case; she was smoking a fag when I got to her flat. All she wanted to do was chat for a bit.

I fixed her machine and she proclaimed herself feeling much better, thanks. She hugged me and kissed my cheek, which was entirely unexpected (I’m not much for hugging strangers) and I left her home with a sense that, although I now had the smell of a thousand fags on my uniform, I had done some good.

The early hours brought me a running call for a man with DIB. He came up to the car and told me that he wasn’t feeling well and had problems breathing. His sats were very low – around 80% and that isn’t good but he looked fine otherwise. I told him to get into the car and that I would take him to hospital myself. On the way I came across another FRU and saw my friend and colleague dealing with a man who had been hit by a bus. He had a badly fractured leg and I called Control to advise them that, although I had a patient on board, I was needed here too. I got a chaperone to take care of my new friend in the back (who was entirely stable) and helped with the RTC I had come across. Periodically, I asked one of the armed cops who were on scene with us (they are all around the West End, you just can't see them) to pop his round and check that my patient was okay. I forgot to factor in the tension an armed man would create without announcement.

As soon as an ambulance was on scene and the injured man was taken on board, I got back to my patient and continued with the journey to hospital.

His sats were still reading very low in A&E and the nurse thought it was a mystery too but he hailed from a high altitude country and I wondered if that had any bearing on his apparently compromised oxygen uptake. Again, I have no time to look into this, so any suggestions from you would be welcomed…just make them sensible :-)

My last job sent me to a very dodgy part of south London for two drug addicts who were apparently unconscious in a flat after overdosing. I didn’t like the sound of this at all and the crew were thankfully with me when I arrived on scene. I asked if the police were available, just in case but I was told that they were busy with a shooting murder from earlier, so we had no back up but each other.

It turned out some foolish young man had called us because his girlfriend had taken cocaine with him earlier and he was worried about her behaviour(!) She was in bed and wasn’t happy at all to have three men in uniform walk in. A lot of fuss for nothing. We left them to it. He would inhabit a doghouse for a while after that.

Be safe.

Friday, 21 March 2008

Sudden death

Ten emergency calls; four assisted-only, one declined aid, one declared dead at scene and the rest went by ambulance.

A horrible shift and one that is still bothering me so much that I have hardly slept properly since. I’m currently in a harsh and frank mood. I’m not someone you want to get on the wrong side of at the moment but on-duty, as always, I will keep my mood in check.

My first call, a Red1, ? cardiac arrest on a bus was a sleeping drunk and nothing more. I know people are scared of seemingly lifeless bodies but a ten second check for breathing, even from a distance, would confirm, in most cases, that they are not dead. I woke him up and escorted him from the bus. I’m doing this more and more frequently these days and I feel like a hi-vis clad usher. In fact, we are nothing more than security for bus drivers in such instances, not that I blame them wholly but a little common sense is required at times.

A 48 year-old homeless drunken man was sitting on the pavement with his suitcase some distance from him when I pulled up to see if he was alright. The local tenant who called us made a point of coming out to tell me that she was worried about him because he wasn’t moving and was lying on the pavement. Now, she said, he seemed to be just drunk and she was sorry I had been bothered for nothing. I thanked her and said I would check him out anyway.

‘F**k off. I don’t need to go to fu**ing hospital!’ he ranted after I asked him if he needed any help.

The crew turned up and the paramedic gently backed off after receiving the same verbal assault. This was later changed to a slurred conversation about where he was going and what he was going to do for shelter. He clearly knew his mind and that was fine with us. I reunited him with his estranged suitcase and left the scene, followed immediately by the ambulance.

We all know when someone is faking unconsciousness - every time. The 35 year-old female that I encountered on my next call didn’t know this and she flopped and flailed on the floor of a ladies public toilet at a train station. The police had been called to her when she was discovered and it became clear to me after a few seconds that she had issues and was trying to deal with them by pretending to be somewhere else. I convinced her of my ability to overturn her game and she eventually opened her eyes and communicated...a little. She told me she had taken ‘some pills’. Her problem wasn’t medical but she had to go to hospital now because I didn’t know what she had taken or how much. The crew arrived to a more able patient, even though she dragged her feet during the walk to the ambulance.

Another woman with issues was found in a callbox after a fruitless search by the police after my call for a 42 year-old female with chest pain led me to a riverside hotel. She wasn’t there and I suggested we try the phone box because I could see someone lingering inside. Sure enough, it was the patient but she wasn’t pleased to see the cops. She told me she had mental health problems but wouldn’t specify what they were until after the police left and I led her into the ambulance when the crew arrived. She was schizophrenic. You can see that in their eyes; it’s like looking at two people at once, each with a different personality.

‘Just leave me here’, she said after attempts were made to conduct the simplest of tests. She was very suspicious of the ECG and we had to explain at length the reason for doing it. In the end, we settled for a 4-lead and she was taken to hospital. Her chest pain may have been real but her behaviour made it impossible to get any impression of sincerity.

I got my next call from the station and the crew were sent just after I left. A 35 year-old woman was having severe DIB and her inhaler wasn’t working, so I sped off towards the Euston Road, where I would have to make the dangerous transition from one side to the other using my lights and sirens to create a safe pathway. Tonight I nearly got killed in the process. All of the traffic had stopped on one side and I crawled across so that heavy traffic in the other lanes could see me and slow down, which they did. A large articulated lorry seemed to be slowing too, so I continued to move across the road but I was being a lot more cautious this time and I don’t know if I had sensed it or I was just being the world’s slowest emergency driver tonight but if I had continued and increased my speed as I normally did, that thing would have smashed right through my car, through me and rolled over me like a bowling ball on a fly. The driver didn’t stop. I could swear I saw him slowing down; it was almost an invite for me to continue but instead he hurtled across my path, feet from the front of the car, as if I didn’t exist. I could see the look on some of the other drivers faces. They were shocked. I was shocked.

The patient I had almost been killed for was hyperventilating and needed nothing more than the sympathy and care of the ambulance crew for twenty minutes while I composed myself in the car outside.

The lorry wasn’t what destroyed my shift and left me feeling numb to this moment. It was something more tragic and less to do with me than you’d think.

I was on station with a technician crew when I received another call. I went to the car knowing that the crew had also been called to the same job. I read the description when I pressed my ‘amber to scene’ button. It read '39 year-old male, jumped off building'. I started moving fast towards the scene and an update on my screen informed me that ‘the caller believes he is dead’. No CPR was being performed because the caller had refused to do it. Instead, when we arrived, the police were there and one of their officers was busily jumping up and down on the chest of a man who was lying on the pavement below a high building. I got out and went over to the patient. He had head injuries and there was blood around his eyes and mouth; he was in cardiac arrest and the ECG monitor showed asystole when it was attached. The crew began to work on him and I prepared everything I’d need to continue resuscitation efforts before conveying him directly to hospital...that was the plan.

Unfortunately other events dictated what I could and could not do for this dying man. I can’t detail them here because there are sensitive issues I mustn’t discuss on a public space but I will say this – the conclusion of this particular call left me feeling hollow and useless for the rest of the shift and even into today. The one thing I remember most of all - the thing that burned into my mind as I left him there to die was the gold wedding ring on his perfectly manicured finger.

And so I carried on with my routine and attended a 45 year-old man who walked from his house to make a phone call about his chest pain. He was still sitting near the phone box when I arrived in the early hours of the morning – he windmilled me as I approached. He has had three MI’s in the past and a long history of angina, so his complaint had to be taken seriously. His BP was high and I started him on O2 until the ambulance arrived and the crew took over.

Then off to see a 47 year-old man who claimed he was vomiting blood but wasn’t. He was lying on the floor of his flat when I got there and wouldn’t move or communicate at first. There was no blood on his tongue or around his mouth and that familiar metallic smell wasn’t in the air, so I persuaded him to tell me what was really wrong and he gave in. ‘Just put me back in bed’, he said. The crew knew him – he had psychiatric issues and was usually drunk when they dealt with him. He’s known to be aggressive but I just happened to find him on a good night. I found that suggestion ironic after the events of earlier. He didn’t want to go to hospital now and even though the crew spent almost half an hour persuading him, he made an excuse to go into his bedroom before diving into his bed like a naughty child who doesn’t want to go to school. He was left there and I went back to the car.

Another unconscious drunk on a bus outside Australia House and I had my hand shaken this time by the culprit. He was a 26 year-old man and he seemed grateful that I had woken him and apologetic for the inconvenience caused.

Finally, a 29 year-old female with chest pain and a fast heart rate. She was in a private clinic, in their critical care unit and I was hardly needed. What they wanted was an ambulance crew to transfer her for NHS treatment, so I felt a bit useless. On my way out I stopped to look in on one of their patients – a premature baby on life support. It broke my heart to see it.

Be safe.

Tuesday, 18 March 2008


Five emergencies – one left scene, one conveyed in the car and the others by ambulance.

I didn’t do a thing until almost 11pm. It’s unusual and I’m not complaining about the rest but unfortunately, the quiet period couldn’t have been predicted, so I never quite knew when a call would be coming in – thus no possibility of actually recharging my batteries.

When the first call came in, I was sent to the City for a 25 year-old man who was unconscious in the street. I was expecting to find a drunk asleep on the ground but when I arrived, the man was sitting up and there was someone with him – the person who had made the call. As I approached the patient, I heard the caller telling Control that I was there now. Then he hung up and walked away, without a word. I thanked him and got a weak wave as he walked off, leaving me with the patient.

I had to assume that he had been found collapsed in the street because the call description stated that he had been in and out of consciousness. He was sitting up now but he wasn’t with it at all. Every attempt I made to communicate and ask simple questions like ‘what’s your name?’ was met with a look in my general direction, an ‘uh?’ and a quick drop of the head. I asked him if he’d been drinking; there was a powerful smell of alcohol and urine or a mixture of those and faeces – I couldn’t quite make it out because the aroma was fused. Whatever it was, I found it offensive when I got close. His response to the question was to nod. I took that as a yes.

Then I asked him if he was a diabetic because his behaviour just didn’t fit with simple inebriation somehow. He nodded his head to that too. I checked his BM and it was marginally low; not critically but enough for me to consider that it was dropping, so I got the Glucose gel out and tried to get him to eat some but he spat it out immediately. I was in the middle of the pavement alone with this guy and people were beginning to hover around to see what was going on. I got no help, however.

I got my bag out of the car and by the time I got back to him, he was unconscious. I gave him an injection of Glucagon, which was awkward as I had to hold him and try to work around his heavily sleeved arm to do it. Still, even though they could see my struggle on this freezing night, nobody offered to help. I considered asking the nearest nosey person to me for assistance while I continued my treatment but I thought I’d best just get on with it.

Then two police officers showed up and I got the manpower I needed. The patient was still unconscious and I needed to get him out of the cold. There was no ambulance available for me and I didn’t know how long I would be waiting for one. After a thorough examination, I had the patient lifted into the back seat of the car and I thought seriously about taking him directly to hospital rather than wait but Control advised me that an ambulance was finally on its way.

Meanwhile, the man was waking up a little but he still didn’t make any sense. I thought about the possibility of drugs and checked his pupils; they were pinpoint. He wasn’t just drunk – I couldn’t believe that was all there was to this, so as soon as the ambulance arrived and we got him in the back, we checked everything again. He was mildly hypothermic, he was becoming unconscious again, his pulse was slowing and his BP was low. He had no injuries, so his condition was a mystery. I gave him narcan and put fluids up to stabilise his BP. We got him rapidly to hospital and by the time he was in Resus, he was more alert but still not making sense. He may well have taken some other kind of drug (narcan only works on opioids) because the answers to the questions posed by the nurse were childish.

‘Where do you live?’ she asked.

‘Mars’, he said

‘How old are you?’


Said it all really. I wonder if he’s been at the chocolate?

I didn’t get called out again until the early hours of the morning. I had spent almost two hours with the last patient and I got back to the station for a break. Now I was off to Camden to help a 42 year-old female who had called us from a public telephone. She had a personality disorder (which wasn’t specified) and was complaining of chest pain. Unfortunately I couldn’t help her because she abandoned the call box when I arrived on scene. I saw her in the middle of the road during an area search – she waved at me in a ‘hello, I’m here’ sort of fashion, then took off with a couple of dodgy looking blokes. She wasn’t interested in going to hospital anymore. My guess is, she had scored what she was after all along.

When the clubs started chucking people out, at around 4am, I got a call for a 20 year-old female who was drunk and couldn’t stand up – this, I thought, was the very reason for drinking in excess. I helped her get to her feet and she promptly collapsed again, wailing about her condition. The crew had to lift her onto the trolley bed and baby-sit her all the way to hospital.

An 80 year-old female with a history of CVA fell onto her bathroom floor and split her scalp open. It wasn’t serious but it would need to be closed properly to prevent infection. There was also the possibility that it wasn’t a simple mechanical trip and fall, so that too needed to be investigated, although she looked and sounded perfectly well. She had a roaring log fire on and it seemed a shame to have to leave when the crew arrived. I went back out into the cold morning and headed to my base station in the hope that I would get home on time.


A last minute call for which there were no other resources except me, apparently. A 13 year-old boy who had been hit by a car the day before had been found collapsed in the street complaining of a sore head. As soon as I read this I didn’t believe it. I got on scene within a few minutes and there were two people with the young lad; an off-duty police officer and a female passer-by. He had been slumped against a wall when the officer, who had just stepped off a bus on his way to work, came across him with the woman. He had told them that he had passed out last night after being hit by a car. He repeated this to me, regardless of the fact that I wasn’t asking him about that anymore.

‘What are you doing here at this time in the morning?’ I asked him again and again.

‘Last night I got hit by a car. I passed out’, he mumbled over and over.

‘Yes but that doesn’t make sense, does it?’ I said repeatedly.

I told the police officer that I was suspicious. I pointed out that if he’d been hit by a car, he would have spent at least last night in hospital, so why was he wandering around at this early hour with a bag? It didn’t work for me at all and I could tell by the way he avoided direct questions that something else was going on, so I requested the police to scene.

I continued to ask the boy what he was doing there and he insisted he had been hit (now it was a glancing blow) by a car, had wandered off and passed out on a park bench, where he had been all night. Again, I didn’t believe him. He didn’t have a mark on him and unless the driver of the alleged offending vehicle was a criminal, he would have stopped and tried to help. This wasn’t the first time I had come across this excuse from a young boy in trouble; I’ve posted before on the subject.

When the police arrived, I explained the situation but the mystery was about to be solved; the officers had been looking for him all night – he had been reported missing by his mother after they had argued and he’d stormed out of the house. He’d obviously wandered around all night and needed an excuse to get back home without incurring the wrath of the authorities and his parents. I understood this thought process because I’ve done it myself when I’ve run away from home as a youngster. It’s difficult to just go home – you need a buffer so that you can be accepted again without consequences for the worry you’ve caused, so being hit by a car and passing out (therefore not your fault) seems to be the popular choice these days.

I took him to hospital with a police officer as his chaperone and I booked him in to the children’s A&E where he’d be safe and await his mother.

This young boy played a dangerous game. He spent the night wandering around, making himself vulnerable and easy prey for some of the worst people that exist in those dark hours. If he’d spent the night on a park bench, as he’d stated, he had put himself in even more danger but it was freezing overnight, so I think it’s more likely he found a quiet, well-hidden doorway to crawl into for the night. He must have been lonely and terrified.

Be safe.

Monday, 17 March 2008

Faulty circulation

Eleven emergencies – two assisted-only, all the others went by ambulance.

A 3 day-old premature baby was fitting and her young parents were, understandably, worried sick about her. She had been born three weeks before her time and was sent home with her mum and dad as soon as she had been checked over and judged fit for life in the outside world by the doctors. Now she was coping with a minor infection and had probably suffered a minor febrile convulsion, although nobody had witnessed this and her mum’s description of what took place didn’t fit the bill. The baby had simply been shaking or shivering on the bed. Mum was seriously worried because this ‘wasn’t like her at all’ but I wondered how much she actually knew after only three days of being with her child. The crew were happy to take them to hospital though and off they went. At least she would have the weight of thinking the worst taken from her inexperienced shoulders.

My MDT was playing up tonight and some of the calls I received were not getting through to my car’s system – this was slowing me down as I struggled to get to where I needed to go with the basic information required until the stupid screen lit up with everything I should have been given before I set off; very frustrating.

I climbed a long way up a spiral staircase inside a theatre to reach an 18 year-old male who had suddenly collapsed during the show. I was a bit hot when I got to the top and I found the crew already attending to the young man, so I wasn’t really needed. I climbed all the way back down and out into the cold air, which for once was refreshing.

An embarrassed bus driver tried to explain to me that he had tried everything to wake up the slumbering drunken male that now resided on the back seat of his bus. The 20 year-old opened his eyes as soon as I prodded him. The best approach with all of these ‘drunk on a bus’ calls is to weigh up the sleeper before you wake him because there is a very real danger that he won’t be pleased and will lash out at you with a fist, a foot or a weapon before you have time to step back and get clear. I always keep my feet alert for an instant decision to back off. This time, however, Mr. Sleepy-Head yawned, stretched and walked off the bus with no fuss at all.

The bus driver had been telling a couple of women who happened to be standing at the bus stop how hard it had been to get the man to wake up. Apparently, he had thumped hard on the outside window, just where he had laid his head but to no avail. He hadn’t actually gone up to him and touched him.

Just to compound his blushes, despite my call to Control to cancel other resources, the ambulance screamed in, followed closely by one police vehicle, then another. We don’t usually get this kind of back-up for these calls, so I was a bit surprised at the party we had gathered. The sleeping drunk was long gone. Probably on another bus by now.

In a restaurant in W1, an 86 year-old man had fainted. I was called to go and treat him and he was still quite out of it when I arrived a few minutes after the event. The man had a history of heart bypass surgery and now looked very pale and shaky. He obviously wasn’t well and the crew showed up within a minute of me to take him and his wife to hospital. I asked him how he felt and said ‘very sleepy’.

A 31 year-old female with learning difficulties dialled 999 for chest pains which were in fact abdominal pains. I reminded her over and over again that what she was pointing to as her chest was her belly but she just didn’t get it and I gave up trying after a dozen attempts. ‘Can you look at my heart?’ she asked me. Her description of the pain and my obs suggested nothing more than indigestion but she would still have to go to hospital, just in case. I left it to the crew to carry out the rest of the obs, including an ECG, if that was their decision. The pain had gone before I got there and based on what she told me, I suspect she may have passed wind and that was the cure.

On my way back from that call, I got another which took me to the Euston Road for a RTC involving a motorcycle and a car but it was cancelled just as I approached. I got another call instead, taking me past the incident and south for a distance. I watched as another FRU pulled out just in front of me to attend the RTC and I couldn’t believe that the proximity had been an issue with FRED. As I past, I could see that my colleague was having a tricky time trying to keep the patient stable, as well as deal with a very dangerous traffic situation – cars and buses were passing very close to her. I stopped, got out and quickly asked her if she needed my help. She thought I had been tasked to this call but I told her I was on another. Obviously, she was happy for me to stay so I went to the car and called Control to explain that I was required to assist on this RTC. There were no police on scene yet and the first thing that needed to be done was to make the area safe.

I used the car as a block against traffic invading the treatment area and I asked people who had gathered around to go away (please). Then I helped my colleague sort out the patient, who was a young man with a head injury – not life-threatening but still nasty. His helmet had come off when he was hit by the car and now his bike was lying crushed under the wheel of the offending vehicle. He was very lucky not to be there in its place.

I spent twenty minutes on scene assisting my colleague and the ambulance crew when they arrived, then I made my way back to the station for a cuppa but that plan was thwarted the minute I poured the water into the cup. I was off to a 24 year-old male who was unconscious and not alert which as an ironic mix of terms to say the least. He was, of course, drunk. He lay in a shop doorway, surrounded by seven or eight very loud Chinese friends. They thought it was all a joke. The drunken man was alert and had only collapsed in a heap because he was too inebriated to stand up. This, he thought, was justification for dialling 999. I was fuming inside and I lectured him and his friends about whether there was a genuine need for an ambulance here but they couldn’t care less.

‘Do you think you need to go to hospital?’ I asked the man on the ground.

‘Yes, I do. I’ll pay anything, if that’s what it takes. I’m very ill.’ He slurred.

The crew had as much patience for this as I did tonight but they simply asked him if he wanted to go to hospital. He said yes and they duly obliged. To me, it was a simple head and brick wall scenario. If I had my way, he would have gone home with his mates in a taxi.

I still get Red1 calls for ‘life status questionable’ incidents where there is absolutely nothing to rush there for, but like my colleagues, I won’t risk presumption in case one day I’m wrong. Usually, I’m not and the call is inaccurate and purely the fault of whoever made it in the first place. This one was an assault. The man had minor facial injuries and didn’t even want to go to hospital. He was outside a pub, so I’m guessing someone saw the fight and dialled 999 in such a state of panic that they couldn’t even give proper details, thus the Red1 alarm.

An epileptic on a bus next. He was stuck in the narrow walkway between the seats near the back of the vehicle, so it was an awkward job. Luckily, he had stopped fitting and was post ictal. He told me he might have another, however, so getting him out and into an ambulance was a priority. I didn’t fancy trying to deal with his next seizure in the position he was in now. There were a few people around; bus staff and police, so I had to make adjustments to the spectators as the crew arrived. There was no room for them to manoeuvre otherwise. When the area was cleared, the patient was lifted into a chair and taken away to hospital.

In the early hours of the morning, near the end of the shift, I received a call to a 19 year-old male who was having an allergic reaction to his medicine. I arrived to find the man shivering in a chair and looking unwell. His friends were with him and they told me that he had brought medicine for a cold back from India where he had been recently and that he had started reacting to it. He had an erythemic rash but his airway seemed safe. His BP was a concern, however; it was consistently low – sometimes very low. When the crew arrived and we got him into the ambulance, we pondered this situation some more and I noticed that his feet were a little swollen and very red. I considered the possibility that the reaction was causing fluid pooling in his peripheries, which would explain his low BP. His legs were raised but this didn’t help much, so I set up fluids and asked the crew to give him adrenaline, which would reverse the effects of histamine and nitric oxide and cause vasoconstriction, which in turn would raise his BP. This seemed to work because by the time he reached hospital, the redness in his feet had completely gone and there was no swelling. His condition had generally improved. At first, the crew were unsure of my request to use Adrenaline but there doesn’t have to be an airway compromise for anaphylaxis to cause problems; circulatory collapse alone can kill, so it was a judgment call.

I ended my shift with a 21 year-old female who was fitting but I didn’t treat her because the crew was on scene and I wasn’t required. That suited me ‘cos I all I wanted to do was go home.

Be safe.

Friday, 14 March 2008

Domestic abuse

Twelve emergency calls; one assisted-only, one no trace, one false alarm and nine by ambulance.
A 14 year-old girl was allegedly sexually assaulted by a 17 year-old and was now bleeding heavily PV. I was called to attend and requested a female crew if possible, such is the delicacy of such incidents.

She was on a bed in the first aid room of a train station and had been helped by a female passenger when she suddenly collapsed on the train. Only then did the story of what happened to her come out.

She had allegedly met the man on the internet, arranged to rendezvous with him at a hotel and eventually had sex with him. This caused some damage to her and now she was lying there, shaking, crying and bleeding down below. It’s called statutory rape but it will probably come to nothing because of the perceived narrow age difference, but it’s the same crime, whether he is 16 or 60.

Then a 43 year-old male with muscular dystrophy and home oxygen that wasn’t working. I arrived at the small cramped flat to find his female friend of ten years trying to push what little air there was available into his nose via a small face mask. This clearly wasn’t helping because his sats were below 50% when I measured it. He was close to suspending but the woman seemed calm and not at all worried. She had become used to his ‘episodes’ but now he was in dire trouble. Her call had described him as having a very weak pulse and glazed eyes. That was accurate.

The crew arrived as I bagged him to support his meagre breaths and we rapidly moved him, albeit awkwardly, through the narrow, rubbish-filled rooms into the corridor and out to the waiting ambulance. He was stabilised with a bit of effort after five minutes but he needed to be blued in for sure.

A 74 year-old lady with severe DIB and a high temperature was lying in her bed, not communicating at all when I arrived and it took a lot of energy to carry her down the steep, narrow staircase of her home to the ambulance for yet another emergency run to hospital.

I met another ex-nurse tonight. She had collapsed in a theatre after the show and recovered quickly on oxygen. She had never had an episode like that before, she told me and it looked like she had simply fainted. Her BP was low but recovering, so she was allowed to go back to her hotel with her husband. She didn’t want to go to hospital; I think she understood the nature of her problem and realised that it might be a waste of time tying up NHS resources. Her ECG was normal and there were no medical issues of concern.

A no trace in the pouring rain next and the 17 year-old female who had allegedly collapsed was not on scene when I arrived with the police. An area search produced nothing but wet feet (my new boots are defective, so I am back to using my old, leaky pair while I wait for another delivery).

My next call was for a 29 year-old female who was having an allergic reaction. I found her sitting on the loo in a hotel with a couple of decent sized pools of vomit at her feet. Clearly, she had eaten something that didn’t agree with her. Her lips were swollen but her breathing was normal. She had a widespread rash but no itching. Her boyfriend had guided me in to where she was and the hotel staff seemed unconcerned that one of their guests had needed to call an ambulance. In fact, the receptionist was downright snooty with me when I went to get the crew, who were lost in another area.

‘I need to know what’s going on and who the person is that called you’, she demanded as I led the crew to where she was.

I didn’t have time to explain matters and I was put off by her attitude, so I told her she would have to wait. Politely, of course.

The poor woman on the loo was embarrassed and apologetic – tearful and scared. It was her boyfriend’s birthday and she thought she had ruined it but he was more worried about her condition.

As we took her into the ambulance I looked at her lips again and told her she would pay a fortune for the equivalent with Botox. This made her smile and I left with a contented grin and a kiss blown in my direction. All donations gratefully received.

Outside a noisy club, where the Paparazzi wait like vultures for their next photograph, a 25 year-old collapsed drunken girl vomited near my feet. Her friends were frantic because they believed she was choking to death, which didn’t explain her ability to speak clearly. She had ‘only a few’, according to her mates and I didn’t even try to put on a convinced face – I’m past that now.

On the way out of this job I witnessed an argument between a young man and his girlfriend (probably). It got heated and he began to throw her around like a rag doll. He was being extremely violent with her and I couldn’t morally roll by and ignore it, so I stopped and got out of the car, intent on saying something. Then common sense kicked in and I stayed back and called the police instead. At one point this guy had thrown the girl to the ground but nobody walking past tried to help or intervene and I can fully understand why these days.

When the cops arrived (by the truck load) she decided not to take it any further. It was the old ‘but I love him’ syndrome. The police could do noting because he hadn’t actually marked her, so he was allowed to go…she went with him. I hope she’s alright. By her actions I can only assume her brain had been injured.

My second encounter with chocolate came soon after a short break. A 29 year-old man and his friends had purchased some earlier in the evening and were now sick. He was suffering from a racing heart, dizziness and swollen hands too (bizarrely), so I was asked to go and rescue him.

He sat in the now closed pub with a friend and the police and I had a look at the offending ‘wrap’. A small brown lump of chocolate-rolled magic mushroom lay in a small packet. He had eaten enough to cause him problems that would only be determined in hospital and his mates upstairs were lying around, throwing up and feeling miserable. The cops checked on them and told me none of them wanted to go to hospital.

Correct me if I’m wrong but if you take a hallucinogenic drug, you expect a good time, don’t you? You really don’t want to be ill as a result. I’m guessing the purchasers of this particular batch were stitched up. So, if you are offered chocolate in a pub, don’t expect a bar of Dairy Milk.

A call to a 30 year-old ‘fitting’ in a hotel room turned out to be nothing of the sort. She was unwell and had been shaking around to demonstrate her discomfort. There was an awful smell of burnt paper in the room and I had to draw it to the attention of the Manager, who was present, because, even though it was very strong, he didn’t seem to notice. The woman explained that, for reasons only she is privy to, a piece of paper had been placed over the very hot bedside lamp.

A fight outside a nightclub in the West End next and I was left on scene for a long time before the police became available. The doormen had pinned one assailant to the wall and the other to the ground and the alleged victim was brought to me with a cut to his eye. After he was taken to hospital, his friend, who had been hiding in the shadows came over to me and said that he too had been assaulted. He had bumps and bruises around his face and he had lost his glasses and now couldn’t see. Despite my high visibility jacket, he failed to recognise who I was and presumed I was the police. Now that he knew better, he got increasingly angry at the fact that no police were around and caused a lot of trouble by raising his voice and getting in people’s faces, including mine.

Eventually, after the police had arrived and he had calmed down, I took him to hospital myself in the car. He promised to behave and I had to believe him. It was that or a long wait for another ambulance and I figured my colleagues were busy enough.

When we got to hospital I tried to reunite him with his friend but the guy with the eye injury had disappeared – he couldn’t be bothered to wait.

A long run out to the east for a 30 year-old man who was drunk in a spa. It was the early hours of the morning and I couldn’t imagine a spa would be open at this time of day but I was surprised to discover that a private health club stayed open 24 hours and the man in question was relaxing in a beautifully heated environment, with a lot of other men I should add – no women at all. He had taken ecstasy and was clucking a bit but he refused to go to hospital and quite frankly, didn’t need to.

My last call of the night was to a 24-hour Internet café for a 30 year-old male who was unconscious. I figured he might be drunk but when I arrived, I saw him lying on the floor, not moving, with a small crowd of quietly interested people around him. It was like a library inside. A library with a big black man on the floor.

It took me ten minutes to rouse him because I knew he was faking as soon as I started working on my obs. He confirmed that he had taken heroin and I sat him up and we discussed the meaning of life. Well, we didn’t. He decided to inform me and everyone else that he was from Zimbabwe and that he was going to kill the president (of Zimbabwe I imagine) and furthermore he hated the UK, and all who lived in it, white people in particular. I reminded him that he too lived in the UK but that was water and he was a duck’s back.

I had been close to administering Narcan when I first came across him but I’m glad I didn’t because he was raucous enough without being fully awake. Every time he stood, he fell and I had to take the weight, so I sat him on a chair and he addressed everyone around him with insults and other comments that had nothing to do with reality.

It was still like a library in there. The customers just sat and stared. Maybe they weren’t real; maybe they were cyber people.

Anyway, the crew arrived and they weren’t too pleased with their new charge and it took us another twenty minutes to get him to comply and go to hospital. He went like a lamb. Maybe the free NHS care he’ll receive will soften his attitude to this country and it’s people. Maybe but possibly not.

Be safe.