Wednesday, 30 April 2008

Remote medicine

Eight calls; one refused, one GP referral and six by ambulance.

I joined a MRU, an ambulance crew and the police on a RTC involving a car and a pedestrian, in which the patient had apparently sustained a head injury. This wasn’ t the case, however, as we all discovered after we’d piled onto the scene – the 35 year-old patient was up and walking about with no injury to speak of. Still, any RTC where a soft body gets knocked over by a hard metal machine travelling at speed deserves a cautious approach, so he was taken to hospital anyway.

Abdominal pain and hyperventilation are common partners I find – mostly with women I must say, at the risk of being branded sexist. My 32 year-old patient was breathing way too fast and had to be calmed down. She had abdo pain and this was her way of coping with it. I left her in the care of the ambulance crew when they arrived; there’s no point in having too many cooks on a call like that.

My next patient, called Valerie, had an epileptic fit inside a cafe just around the corner from my station. She had suffered a shorter seizure earlier in the day and both her and her mother had decided to cope with it. She had a history of this and they normally just get on with it but today she had a longer fit and more than one is unusual for her, so an ambulance was called. Both Italian and both visiting the country, I found them sitting at a table as if nothing had happened. It had probably only taken me two minutes to get on scene because I was in the station when I was activated.

Her name is memorable because when I asked for it, the song in the background, playing on the cafe radio, repeated it immediately...'Valerie' Ms. Winehouse warbled over the air. It was a smiley ironic moment and it made the crew grin when they heard it because the chorus came back around when I introduced her to them. ‘This is Valerie’ I said. ‘Why don’t you come on over Valerie?’ Amy repeated tunefully.

She’ll be okay but she went to hospital just in case. It would be too risky for her to have another fit while she was outside and near busy roads. Oh, and she was happy for me to use her name.

Traffic was very heavy today – again a mixture of roadworks and sheer weight left me stranded en route to calls. The only vehicles that were getting anywhere on time were the MRU’s and the CRU’s. I may not have two wheels but I’m dry when it rains.

When someone is ‘unresponsive’ you get no information from them whatsoever because, by definition, they have not responded. I couldn’t, therefore, work out why my next call for a 52 year-old ‘laying on the ground, unresponsive’ and thus categorised in red, had a full name given on the ‘patient’s name’ section of the screen. Did he give it then pass out? Was he with people who already knew his name?

I wasn’t required anyway because there was a crew on scene and the reason his name was known was that he was fully conscious but drunk...and still had a hospital ID band around his wrist. Change unresponsive to incoherent.

A regular caller, according to the police on scene, had reported that she was ‘trapped behind a locked door’. She told Careline that she was on the floor and couldn’t get up, so we were called. She had not reported any medical reason for her situation so myself and a crew were despatched, along with two police officers, to investigate and possibly break the door down should the need arise.

When we arrived, I tried to get a response from behind the door but heard nothing. I couldn’t see anyone through the letterbox but I saw that the telly was on. When one of the cops tried calling out to her through it she eventually answered him, telling him she couldn’t move. This went on for ten minutes and a request for the key holder – someone who could let us in on just such an occasion – was made.

While we waited for the key holder to arrive, the officers described how she’d often been found laying, naked or barely dressed and completely drunk on the floor just behind the door. It was her MO for every call; she rarely went to hospital because there was nothing wrong with her, except for alcoholism and a blatant disregard for the efforts of everyone who helped her.

It took almost half an hour for the key holder to show up and in that time, as we peered through the letterbox from time to time, she’d managed to crawl to a position on the floor where her upper body and arms were now visible, sprawled across the living room door. There was little doubt that this was for effect.

When we got in, she was barely dressed, as we’d been warned and very drunk, again, as predicted. There was an empty bottle of cheap brandy on the floor and she had made herself too drunk to stand up. I left her to the crew – they didn’t need me. They didn’t need this either.

My next call was to a local haunt for drug addicts and alcoholics, right in the heart of Euston. It was for a 26 year-old man who was unconscious. The MRU had been sent and he was ahead of me but we both managed to arrive at the wrong location. I searched a little park and he looked further up the road, where he found the patient. The ambulance pulled up a few minutes later.

In a doorway, in full view of people waiting for a bus, a mere ten feet away, slumped an aggressive drug addict who’d probably just taken something. He looked out of it but he wasn’t unconscious although I imagine people looking at him would want to believe he was and so an ambulance was called.

He was okay until he got into the ambulance, where he became abusive, refused further help and threatened to kick off. His reward? He was escorted from the ambulance and told to go away. See, we are polite even in the face of adversity.

A 68 year-old lady, bed-bound and rendered incapable by a stroke a few years ago was my next concern. Her daughter had to look after her with the help of a carer. She was fed through a nasogastric tube and she couldn’t communicate properly. Her limbs were useless and she lived in a specially designed bed at home. This is how she’ll end her days.

She had developed a noisy cough and her chest was very bubbly when I listened to it with my steth. Her cough was worse when she was fed through the tube, so there was the distinct possibility of pulmonary aspiration as a result of initial incorrect placement, which seemed unlikely as it would have been tested for patency when inserted, or that a blockage had occurred. Whatever was going on (and she may simply have had a chest infection), she didn’t look well.

My last call of the shift was for a 72 year-old male with ankylosing spondylitis but that wasn’t why he’d had us called out. He thought he had DIB and his doctor, who didn’t visit him to check on his condition, diagnosed a chest infection over the phone and told him to call an ambulance because he needed an urgent x-ray. I’m sorry if you are a doctor and you are good at being a doctor but don’t you think the same as me; that this just isn’t good enough? I don’t want to be diagnosed over the phone and then passed along a line. I want my doctor to care enough to come and check me out personally. It’s what I’m paying a large proportion of my hard-earned money for and, without a doubt, what the patient has also forked out for over the years.

In fact, he had no DIB; his breathing was fine. Neither did he have any sign or symptom of a chest infection, from the basic evidence I could put together at his bedside. The crew agreed and, after I left to do my paperwork, I saw them leave the flat after advising the patient to call his GP and request a visit this time.

So, I left the land of the sick and injured, wondering what use I’d been to anyone today.

Be safe.

Sunday, 27 April 2008

Survival of the fittest

Five calls; one assisted-only and four by ambulance.

The day started with a call to a 45 year-old male, ‘collapsed ?cause’. I found him lying on his face in the street; the caller, a concerned passer-by thought he might be dead but changed his mind when he realised the body was moving a little.

When I see young, badly-dressed skinny people laying in the street in broad daylight I usually (rightly or wrongly) assume one thing – drug addict. I wasn’t wrong this time because when I shook him awake and he lifted his torso, I found a blue tourniquet – exactly the same as the ones we use – underneath him.

‘Have you just taken heroin?’ I asked.

‘Yes’ he said, nodding in confirmation.

I could be asking a perfectly ordinary person if they were wearing trousers or not, such was his casual nature of his response.

‘Then can you get up and move somewhere less public, otherwise we’ll get calls all day for you.’ I suggested.

Now, I know you’re probably thinking he needs to go to hospital and that moving him along is unprofessional but the fact is, he doesn’t want my help and my colleagues in the assigned ambulance have better things to do.

He stood up and staggered off to the nearest phone box, inside which he’ll slump on the floor and pretend not to be there while he’ll actually not be there, if you know what I mean. His breathing was fine and he showed no interest in anyone’s concerns about his health or welfare – he had his habit and that was all he needed.

A minor knock in which a young moped rider was thrown from her ride by a bus when she veered into its path at slow speed next. She had a sprained ankle but the call was given to me and when I arrived, it had also been given to the MRU, which was on scene and dealing with her. Then another FRU turned up, followed by another ambulance and…for good measure a second ambulance – all despite me cancelling further resources. Thankfully, we didn’t hear the clatter of rotor blades from above. Someone had itchy fingers today.

I took the FRU I was running off the road and got a replacement because the siren wasn’t performing properly and it tended to sound like it was being strangled as the pitch and volume rose and fell to almost nothing each cycle. It confused the motorists because they had no idea where I was coming from and I had a few near-misses when vehicles roamed in front of me. Now I had the much older Astra to run – it’s out of date but it’s fast and responsive, so I was happy with it regardless.

A young Ethiopian man called us for DIB he didn’t have because he’d just had breakfast at a cafĂ© but no money to pay for it. He feigned illness to escape the bill and the crew had no choice but to take him to hospital. He walked casually out to the ambulance and went through the well-rehearsed motions but we all knew he wasn’t sick.

The mother of a Bulgarian family that had just got off a train began to have chest pain as she walked the concourse. I knew how she felt after having to lug all my bags the length of the damned thing to get to her. Every patient will be the maximum distance possible when you have to carry everything – it’s an unwritten rule. They’re on the top floor every time or, as in this case, miles away from where you park.

She may have had a cardiac history but it was undetermined because of the language barrier – her vital signs were normal and she seemed more upset than in physical distress but she was wheeled to the waiting ambulance and taken to the nearest hospital – you never know with these things and it’s better to trust the patient sometimes, in any language, pain is pain.

My last job of the shift was the worst. I was called to a 30 year-old male who’d fallen from scaffolding. No other details were given but HEMS had been contacted, so I knew it must be significant.

The MRU had just pulled up before I arrived and I saw my colleague taking the stairs two at a time into the office building that was being refurbished. A man came out of the building to see me and I asked him how the patient was.

‘I think he’s stopped breathing now’, he said.

Oh, I thought.

I grabbed whatever gear I thought would be needed and ran up the stairs, through an open plan office to where my colleague was. On the way through, another man led a woman out of the door – she was crying.

On the other side of the office the balcony doors were open and they led onto a scaffolding platform at the first floor level. The scaffolding surrounded the building and rose to the fourth or fifth floor. I looked out through the doors as I approached and saw my colleague kneeling beside a young man, probably in his late teens or very early twenties, lying flat on his back. When I got close I recognised cardiac arrest – a pulseless person can be quite obvious sometimes.

We started working on him immediately and it was looking very bleak from the start. He’d fallen through a gap in the scaffolding platform directly above us and crashed onto the deck where he was now, with a serious head injury, bilateral pneumothoraces and God knows what other injuries. He was a lean, strong, fit looking young man and he was younger than my son.

Another FRU pilot arrived and helped with equipment as we continued the fight to save the man’s life. Nobody had seen him fall; a scream had been heard and then he was seen landing on the wooden platform at this level. The crying lady had witnessed him land and that must have been a terrible shock for her.

Another crew showed up and work continued – preparations were made to get him to hospital while we carried on resuscitating him but then the situation changed when two things occurred; first I noticed that his upper abdomen was moving quickly and realised his heart was beating rapidly. I felt it and sure enough, that familiar muscular throb could be detected easily through his abdominal wall. The adrenaline he’d been given would have been responsible for that and the frantic speed of its beat was a typical response to the drug. Then the HEMS team arrived and more intense work began on him, delaying his removal but ensuring the stability of his condition.

The pneumothoraces had been dealt with by punching cannulae into the chest wall and he was put on a respirator – no chest compressions were needed now that he had a steady heart beat.

He was collared and put into a vacuum splint for the journey to hospital. We carried him awkwardly down the stairs and outside. His eyes were open and he stared up at me with large motionless pupils. If he survives, he may have brain damage.

Traumatic cardiac arrest in young people is one of the worst scenarios we have to deal with and, personally, I have a tendency to want to work harder and faster at keeping them alive, probably because I’m a family man myself, I don’t know. I’m not suggesting I’d work with less care if it was an older person, I’m just more motivated because I know that young people, although capable of surviving trauma better than old people, have less of a chance when oxygen deprivation kicks in since their demand tends to be greater normally (leaner muscle mass and healthier organs require more fuel). A drop in oxygen levels for a sustained period may lead to organ failure or brain damage in a shorter time than it would for an older person – even second-long delays with a young person in cardiac arrest could, therefore, have life-changing consequences.

I think he will survive. I’m just not sure how life will be for him if he does.

Be safe.

Friday, 25 April 2008

Walking wounded

Ten emergency calls – two conveyed by me and eight by ambulance.

Born before arrivals (BBA) are tricky calls because you never know if complications during the delivery are going to present you with on-the-spot decisions that are rarely practised. I’ve had a few bad calls in the past and I’ve settled down with them now because the last few have been straight forward but this type of job still has an edge.

Luckily, there were already two crews on scene, one of which was inside dealing with the patient. The baby had been born without a hitch and, apart from standing by in case a midwife was needed, my involvement was insignificant.

Underage drinking is becoming a major problem these days and my next call, to a 14 year-old boy who’d been found by a private paramedic, collapsed at a bus station, highlighted the dangers of boozing to excess (or at all) when your body isn’t mature enough to handle it.

He was semi-conscious when I arrived and had been vomiting on the ground. He was very cold and quite incapable of talking coherently. As I attended him and waited for an ambulance, his mother appeared with her friend. At first I thought she had left him to his own devices and he’d gone mad with alcohol but I learned later that he’d been out all day with his cousins and friends and they’d obviously been hitting the Stella hard in a nearby park. Now he was on his own and too drunk to get home safely.

The ambulance arrived and we packed him away just as his very angry father appeared on scene. They’d been called by the bus station management and it was clear that his condition wasn’t approved of by his parents, especially dad, who looked like he was about to storm the ambulance and give the boy a good hiding. I had to step in front of the irate man and try to calm him down; he wasn’t getting on the ambulance in that state.

‘That’s my son in there!’ he bellowed at me, with no trace of pride. I kind of understood his irritation and embarrassment.

Meanwhile, mum was crying about it all and she got to ride to hospital with him. Dad got to go back home to cool off, probably at the request of mum’s friend, who appeared to be the calming influence.

A two minute run to a man with chest pain outside a Burger King next and I found myself attempting to glean information about his cardiac history from his English-speaking colleague. There were five or six of them – all Norwegian businessmen. They attempted to get into the car before I’d even got out, which I always find unnerving, so I barred them until I ascertained the nature of the problem.

The patient had central chest pain and looked quite ill – he had a previous history but I couldn’t get a clear translation of it, so I made an assumption that he’d suffered a heart attack in the past. His pain wasn’t improving and I was told by Control that the nearest ambulance was at least twenty minutes away. The nearest hospital, however, was les than two minutes away, so I bundled him into the car and drove him there – not something I would normally do with such a patient but I could see no other way, unless I waited the duration with him as he got worse. I’d given him GTN and aspirin and his obs were good, so the risk balance was in my favour and that’s how it had to be. I have to say I’m neither comfortable nor happy to have to make such decisions but until we get the alcohol-fuelled call numbers down and route ambulances to more deserving cases, this is how I have to work.

As if to prove my point, the next call was for a 30 year-old drunken man who was so out of his tree that he couldn’t stand properly. His obviously long-suffering wife was with him and she battled through tears and despair to get him to comply with us and go to hospital. The crew were on scene with me and two of us balanced him as we tried, again and again, to persuade him to get into the ambulance. He was stubborn and verbal; sometimes abusively so and he tried to punch me away from him at one point.

This wasn’t a street survivor. He wasn’t an alcoholic in the mainstream way of thinking – he was a professional type, suitably dressed for a night out and with a perfectly decent wife who stood by him but he was clearly someone with no control over his drinking when he got down to it. I know many people like this and I can never work out an excuse for them – you either stop drinking when you know you’ve had enough or you don’t drink at all because you never know when you’ve had enough.

It took us almost half an hour to get him into the ambulance and I’ve no idea how much longer he remained belligerent with the crew because I left the scene as soon as possible after we’d stowed him away.

We can’t do much for you if you’ve been diagnosed with an illness and are currently receiving treatment, especially antibiotics, for it. You need to let the drugs work and that might take several days. We often get called to people who want to go to hospital because their meds ‘aren’t working’ when in fact, they haven’t even given them a chance. My 78 year-old patient’s son told me that she had been diagnosed with a chest infection and given antibiotics that day but now she felt worse and was coughing a lot more. Apart from that, she was stable and sitting in bed looking fed up. I sympathised with the emotion but could do nothing for the ailment. I left it to the crew to help her make a decision about going to hospital.

Again, people who’ve only ‘had a few’ – especially women, are not supposed to be in a collapsed state with severe dehydration. A 20 year-old lady was being propped up by her friend outside the club they’d both exited. She had vomited on the steps and was now completely out of it. It took a bag of fluids to bring her BP up to normal and to regain some level of consciousness by the time she reached hospital.

On the way in the car (travelling behind the ambulance) I was stopped by a police officer who asked if I could attend to an assault victim. The crew didn’t need me so I took the running call and let Control know. A 22 year-old Italian man, with no English, had allegedly been hit over the head with a bottle earlier and now he couldn’t hear well in the ear that had been clubbed. This could be something or nothing but I took him in the car to hospital for a check-up and we arrived as my drunken, IV-attached patient was being wheeled inside.

The A&E department was busy and a patient who’d been brought in by another crew (drunk, of course), wandered around the area making a nuisance of himself until he was put back in a chair by staff – he promptly fell asleep and later on I saw the nurses struggling to get him to wake up again.

A man with a drip attached to his arm went to the toilet and a few minutes later walked out and past us with blood dripping on the floor. There was no longer a bag, line or drip stand with him and I followed the blood spots to the loo to find he’d left them behind. He’d ripped the IV from his vein and there was a large pool of blood and a streaming fluid bag lying on the floor by the toilet bowl – nice.

Later on I was called to attend another assaulted man, this time a Royal Marine who was in town off-duty after a seven month tour of Afghanistan. He and his mate had gone to the defence of a female who was being harassed by a group of men in the street. They paid for their chivalry with a beating when the mob of a dozen men allegedly attacked them with bottles, lumping his mate on the head and knocking my patient out. Now he sat on the pavement, swearing like a trooper, vowing revenge and bleeding from a deep laceration to his forehead. He also had a chipped front tooth. I imagine he’s seen much worse.

Momentarily, he became a little confused and I think he thought he was back in the wars when he was in the ambulance because he referred to people and things that weren’t there – he was probably concussed but apart from that, he seemed fine.

I have to say, right now while I have the chance, that I have the utmost respect and the highest regard for these young men and women. Whether it’s politically correct in your view or not, they are simply following orders, just as they’d do if we asked them to defend us from invasion. I know there’s a lot of suffering on either side and I don’t want to get into a heated debate with anyone about this; we all have opinions to express, but can we give them some credit for their bravery, tenacity and patriotism? Just a little?

He told us that he’d applied to become a paramedic but was told he was too young. Ironic, I think; he’s too young to pick up drunks but he’s old enough to fight for his life every day of the week.

Another ‘unconscious on a bus’ call in the wee small hours and again this one decided to get feisty when I’d finally woken him up. The crew were on scene when he opened his eyes and he became a little aggressive and resistant. His fist almost caught me in the face as he flailed his arms around and I’m probably on high alert for that now, so I shouted a little too loudly at him for it to my shame but at least he quietened a bit. I refuse to go home with a black eye or a broken nose if I can possibly avoid it.

Just as I made my way back to base I got a call for an overturned car. There were no details of anyone being inside the vehicle and I wondered why we were needed, although cars don’t tend to overturn on their own, so I was a bit suspicious of this lack of info.

When I got on scene, this car (pictured above) was doing the dead fly and a young man was sitting on the pavement with an ambulance crew tending to him. He’d walked away from this with only a partially amputated little finger, which must have got caught in the structure of the vehicle as it flung him around. He might have fallen asleep at the wheel and the tree he hit (also pictured) looked like it assisted his flight into the middle of the road. Luckily for him it was still too early for much traffic to be around; otherwise he may not have been able to walk at all.

I try not to underestimate the ability of the human body to survive things like this. When the most minor accident can result in death and the most major event produces nothing more than a scratch, you come to terms with the fact that being in the right place at the right time or vice versa, can contradict your professional estimation of the outcome.
Be safe.

Tuesday, 22 April 2008

Drugs for the hell of it

Five emergencies – all went by ambulance.

If you have an anaphylactic friend who carries an Epipen or Anapen, don’t panic when they tell you they’ve eaten something nasty, like a peanut and they’re swelling up. If you use the injection device too quickly and without calm rehearsal, you’ll waste an opportunity to save their life if things become a little more complicated later on. If they just have a nasty rash and a bit of a puffy face, they’re not yet in danger.

The friends of a 30 year-old female who ‘fainted’ whilst having a reaction was injected twice; once by her friend, who failed to get it right and the adrenaline went to waste, and again by a stranger who happened to know what to do (well, she read the instructions) and managed to get the stuff into the patient’s muscle. The fact is, she didn’t really need either injection and it’s just as well only one of them took effect, as 0.6mg of adrenaline (small dose as it is) may have had the patient’s heart running a wee bit faster than it should while she was intoxicated.

Her BP was high, as expected, but it soon settled down again. She was convinced she was having a life-threatening reaction to something she ate and had instructed her mates to inject her. Neither of her friends was particularly confident about it and one of them repeatedly berated herself for getting caught out – hardly her fault and at least she tried to do the right thing.

Whether the lady in question actually had a reaction is debatable but the Epipen was an extreme measure, given her condition when I arrived – there was no life-threatening airway problem and very little evidence of swelling anywhere. Maybe she panicked.

Another allergic reaction and this time the 28 year-old man was convinced he’d eaten a peanut or a meal with peanut in it but again he looked fine – a little shaken up but alive. There was already an ambulance on scene and I popped my head inside to see if I was needed – I wasn’t, so I left to do my paperwork.

I wonder if there’s an element of panic-stress involved in people with sensitivities combined with alcohol. I’m not presuming that I know how they feel, of course, I just wonder if it’s worth further study. Maybe a moderate alcohol intake increases a person’s fear of allergic reaction or it creates the illusion of symptoms associated with it.

Into a West End casino for a 35 year-old female with chest pain next. She was Russian and couldn’t explain her known congenital heart defect clearly for me to understand what it was and how it could be connected to her recent experience of chest, sub-scapular and left arm pain. I didn’t want to take a chance and when the crew turned up and an ECG was carried out (confirming nothing in particular), I advised her to go to hospital.

A red call that should have been green – ‘chest pain’ had been given for someone with 'shoulder pain'. I queried it but got the usual stock answer; ‘that’s what the caller said’. This wasn’t exactly the case when I got on scene. The patient, who’d dislocated his shoulder while dancing (don’t ask) denied claiming that he had chest pain and the caller, one of his friends, denied it also.

He was a nice lad with gritted teeth (such was his pain) but his mates thought it was hilarious. Dislocations are very painful, especially at large joints, so I sympathised. He’d need morphine because the entonox wasn’t touching it.

Then another surprise when the crew showed up and it wasn’t the LAS. In fact I didn’t even recognise the uniform at first. The St. John Ambulance (SJA) were running on emergency calls tonight apparently – not that I knew anything about it, so it was a bit of a shock to realise that I wouldn’t be handing over to a crew I knew had the same training as me but instead I’d be handing over to three young people with basic ambulance aid knowledge (they told me). They were very nice people but unknown entities on a busy Friday night make me nervous and I’d much rather see one of my own crews arriving to help me out and take over the care of a patient – no offence to the SJA, of course.

The last call of the night, for example – this is when I need professional crews I know and trust. An unknown male was unconscious after taken GHB. The caller had given the wrong address several times and I crawled up and down the road given with the ambulance crew. It was ten minutes before the caller got some of his facts right and we were directed to the far end of the road we were on and it was only by accident that I was waved down by a delivery man who pointed to a window on the third floor of a building I wasn’t going to. A windmill was leaning out of it, so I let the crew know where I was heading and parked up.

The man met me at the gate and led me upstairs. The place reminded me of the grotty house that Steptoe and Son used to live in.

‘We were having sex and he had some kind of fit and then wet himself and fell down’, the man explained nonchalantly as he took me to the very top of the narrow staircase.

It was more than I wanted to know as I lurched into the darkness behind him. I could hear the crew arriving outside, so I wouldn’t be on my own with this guy for too long.

I was led into a dimly lit bedroom, cluttered with rubbish, and I could see no-one else. The man went to the side of the bed and pointed.

‘We’ve both had GHB but not a lot.’

I looked over and saw the patient for the first time. He was lying on his back, eyes glazed, mouth open and the very last breaths were coming out of him as he grunted into oblivion.

I went to his side and opened his airway. I got no response (and I wasn’t expecting any), so I continued with the most basic emergency care...airway and breathing. The crew arrived and I think they were just as taken aback by the sudden drama as the man who’d led me here.

‘Is he alright?’ he asked stupidly.

‘No, he’s not’, I replied sharply.

Although there was a paramedic on the crew, he wasn’t yet registered, so couldn’t carry out all of his skills or give many of his drugs unless supervised, so I was carrying the can alone on this one. I suggested that we move fast and get the patient to the ambulance but we had a problem with the carry chair; it had become damaged and wouldn’t support the patient’s weight safely, so we wre stuck there until a solution could be found.

We were now supporting the man’s breathing with a bag-valve-mask (BVM) and oxygen. An OP airway had gone in without a gag reflex and his pulse was slowing to a crawl. He would arrest soon if we didn’t do something to change the situation.

I looked at his pupils; they were pin-point. I had been told that he’d only taken GHB and cocaine but I was convinced he had taken much more than that.

‘Let’s give him narcan’, I suggested.

He was given 800mcg of the stuff IV and we waited for a response but got nothing. I had called control to request another ambulance and had made it clear that we couldn’t wait but wait we did...for another 30 minutes.

All the while, the man who’d brought me into this crazy situation was pacing about but not looking particularly worried. He’d only met this guy tonight. They’d had drugs to fuel their passion and then sex, during which he’d mistaken his new mate’s heavy, noisy breathing for excitement when, in fact, he’d been having a seizure. It was only when the man had lost bladder control and wet the bed that he’d realised something was amiss and had stopped. If I was in the same situation, I’d be worried sick.

I had broken open the first glass vial of narcan and it had cut my finger through my glove. Now blood was running over my finger underneath and I knew I was risking infection with this job. I decided to intubate the patient, there and then, rather than wait another eternity for the second crew I’d requested, so we moved him onto the bed and I got started but just as my laryngoscope blade left his mouth (I’d scoped the airway but it was too risky to try), his eyelids fluttered. Then the new crew entered the room.

Now we had enough hands to safely remove this patient. His condition changed as a Laryngeal Mask Airway (LMA) was put in his mouth – he began to gag and retch; this meant his level of consciousness was improving. It had taken 1.2mg of narcan but now he was further from danger than he was an hour before. We knew it wouldn’t last and it didn’t - he slumped back into unconsciousness as we carried him downstairs. He was given more narcan during the trip to hospital and taken straight into Resus where his life would be saved.

‘He’s got blood on him’, the doctor said in a worried tone.

‘Yeah, it’s mine’, I told him.

Be safe.

Friday, 18 April 2008

Patient reminders

Six calls; All went by ambulance.

My first call of the night taught me a lesson in how not to assume a conclusion. She was a 35 year-old Chinese woman who’d ‘fainted and had a rash on her face’ at a hairdressing salon. A crew were on scene just ahead of me and I went into the small building with them expecting, as in the majority of such calls, to find a fully conscious person slumped on the floor in a dramatic way.

Sure enough, there she was – sprawled across the tiles with someone talking to her and all of us made the same assumption that she would be taken down on foot (the stairway was very narrow, winding and treacherous) or by chair if absolutely necessary.

She wasn’t communicating with us and, as far as we knew from her relatives on scene, she didn’t speak English, so it may have been for that reason that she chose not to speak at all. Neither did she make any voluntary movement and, from the smell I had picked up in the room, it was possible she had lost bowel control – now, that was unusual for a simple faint.

In a short five minute period during which we asked pertinent questions of those around us and carried out observations on the patient, it became clear that something was badly amiss. There was a packet of paracetamol on the counter and I asked if she’d taken them as a couple were missing. Her relatives confirmed that she’d had two earlier for a headache.

The rash, which appeared to be just on the left side of her face couldn’t be explained but it looked more reddening skin, as if pressure was being applied from beneath the surface. She was posturing decorticately now and that meant only one thing – she was in serious neurological trouble and had to be moved fast. A quick look at her pupils confirmed our suspicions; one was much larger than the other.

As we began to lift her onto the chair she vomited violently and repeatedly and we hurried her downstairs and out to the waiting ambulance as fast as we safely could, whilst maintaining her airway.

She was quickly cannulated and we could see that she was becoming more and more bradycardic by the minute, so all the other work was done on the way to hospital. I followed the crew in the car, in case the paramedic needed me further en route but we got the patient to Resus and I left shortly after the handover.

A minor injury for a 27 year-old man who fell into the side of a bus as it pulled in to the bus stop. He was a little tipsy and lost his balance too close to the vehicle. His face made contact with it at low speed and he was thumped to the ground. He had a cut lip and damaged nose and was picked up by a passing first aider who called us and handed him over when we arrived. The crew were just ahead of me on scene but I stuck around to see if I was needed. The bus driver was keen to leave and had to be reminded of the law and asked to stay there until the police arrived and took statements.

My second reminder tonight was that I should exercise patience, even when I’m tired and have seen enough stupid drunks for one tour. A 19 year-old student was reportedly unconscious after vomiting blood. He was found slumped in the lift lobby of a University campus building by a gang of fellow students. The ‘blood’ they had distressed themselves about was red cabbage that had been vomited up at the front door, probably as the young man staggered in on his way to his accommodation.

I was annoyed with this because my break – the only break I would get in the entire twelve hour shift – had been interrupted by Control for this call. I wouldn’t get another chance to rest and I really don’t mind that if I’m being asked to go to a suspended or a similarly serious call – but this was ridiculous and the fact that a bunch of higher education students couldn’t differentiate between vomited cabbage and blood made the whole thing surreal.

I woke him up (he was of course just drunk) and waited with him until the ambulance crew arrived. The crew paramedic was much more patient with him (I had been telling him that he should control himself when he drinks) and spoke with an even, soft voice. It made me feel like a bully and reminded me to try and calm down when these jobs come up, even if it cost you the only rest you’ll get. Human nature is a hard thing to control when the pressure’s on.

It was a relatively quiet night but I still felt cheated about not getting a break because it’s the only time you feel secure enough to relax and eat something – you don’t expect to get called out but that security has been taken away, so now I’ll never know when I’m going to be called and that isn’t good for my health as far as I’m concerned. I'm sure many of my colleagues feel the same.

A tall 26 year-old Chinese man was found ‘unconscious’ in the street and I went to see what I could do. He was drunk and freezing and I had no idea how long he’d been on the ground but he wasn’t interested in my help and told me nothing about himself or how he came to be there.

When the crew arrived, they had that fed up look about them; the same one I sometimes get and was trying to rid myself of tonight. They picked the man up and took him into the ambulance, where he promptly spat onto the EMT’s trousers. There was no 'excuse me' or 'sorry', just a pool of sputum as thanks for the crew’s efforts. If this sort of thing happens often enough during a shift, or even a tour of duty, then it's easy to see why a professional veneer can begin to tarnish.

At a club in the West End, a 20 year-old girl had collapsed and the staff first aider was taking care of her as she lay on the stairs unconscious. She wasn’t just drunk, she’d been drugged and it was obvious from her behaviour when I arrived that she wasn’t reacting well to whatever had she’d taken.

The security men were detaining a man they’d seen touching her ‘inappropriately’ earlier and they believed, although they couldn’t prove it, that he’d supplied her with drugs. The crew arrived and the paramedic advised the security guys to call the police if they believed she’d been abused in any way. If I’d been able to speak to them I’d have insisted they call the police because this didn’t look right at all.

We carried her to the ambulance and she continued to wander in and out of consciousness; her eyes were rolling around and her pupils were constricting and dilating every now and then. She managed to speak to the female EMT and told her, load enough so we could all hear, that the man she’d met had given her a pill to take. That was really enough to get the police involved, so I left the vehicle and let the crew get going while I went back to the club to ask that they hold on to the man while the police were activated.

Unfortunately, they had decided to let him go and that meant he’d probably never be caught, especially as they hadn’t even bothered to get ID from him – so no name or address, just a vague description. The police would have to go to the hospital and get a statement from the girl when she recovered but that wouldn't be enough and the guy will probably do it again to someone else.

I know the young girl was stupid to take the pill in the first place but that doesn’t excuse this creep’s behaviour with her when she was drunk and God only knows what his intentions were once he got her out of the club in a drugged state.

If you go out alone, or your friends leave you, don’t get involved with strangers; it’s not worth it – even for sex. Friends should never ever leave you alone if they truly give a damn.

I went to this call thinking I would be treating yet another young drunken woman but, again, I was reminded that not all of the calls we get are as routine as we think.

Finally, a 65 year-old man with chest pain that he’d suffered all day, called us from his hotel room in the early hours of the morning. He was a Russian musician who spoke little English but managed to explain that he had angina, so off he went to hospital.

Later on, I was told that the ‘fainting’ patient had a massive intracranial bleed and, although surgery was carried out immediately, her prognosis was not good and she was unlikely to survive.

Be safe.

Guinness is good for you

Five emergencies; every one of them by ambulance.

A somewhat sleepy and easily agitated 20 month-old boy who’d had a febrile convulsion was my first patient of the night. His worried parents had taken him to their GP when he became hot and unwell. A throat infection was diagnosed and calpol was given to lower his temperature. That was a few hours before he suddenly began fitting; eyes rolling into his head, limbs flailing and stiffening – it didn’t last long, only about 15 seconds Mum told me, but it was enough to cause her to panic.

The little boy had a high temperature, sure enough – 39.1 degrees and another dose of calpol was administered by his father while I watched. I should have taken his BM but he was so upset after the thermometer had been put in his ear that I left that to the crew when they arrived. There was no point in agitating him further or putting the parents through even more stress.

He was taken to hospital for further checks but I’m sure he’ll be discharged in the morning, loaded up with even more paracetamol.

A female feeling faint at a train station next – she was in the ladies toilets and her husband was with her. In fact, including the staff and myself, there were four guys in there and women went about their business without fuss but the hand dryer was getting on my nerves – it was so loud that I couldn’t hear what the patient was telling me, so the loo was cleared of people and closed for the duration.

She suffers from colitis and I suspect she had an intestinal infection, bringing about her abdominal pain, diarrhoea and nausea. She was very weak on her feet, so I sat her down while I carried out my obs. The only remarkable thing I found was that her temperature was sub-normal at 34.8 degrees but I’ve seen this many times when a ‘tummy bug’ is present.

The crew arrived to take her away and as we took her upstairs, I saw the result of my insistence that the dryers be silenced – there was a long queue of desperate-looking women at the entrance.

I don’t mind carrying patients, I really don’t; not when they need to be carried, but my next call, to a 67 year-old man having a panic attack and claiming chest pain, took me to a hostel south of the river where a crew, consisting of two of my friends, were bringing him down three flights of stairs while he moaned and groaned. He had no chest pain, he had back pain but his pain wasn’t agony (his demeanour would have given that away) and he had managed to walk up those stairs earlier. Now he was being carried down on a chair and my colleagues were risking their backs for him. Beyond the call of duty as far as I’m concerned.

An 81 year-old woman bit her tongue and it began to swell up, as you’d expect, but she became uncomfortable with it and, a few hours later, her family called an ambulance, convinced she couldn’t breathe. I arrived with a crew and we found her sitting on a chair in the front room suffering no more than…a swollen tongue. She was a nice lady, though and apologised for the ‘trouble’ she was causing and even though her injury was minor, she may well have been having trouble swallowing and that’s what was interpreted as DIB. She was taken to hospital just in case. It wouldn’t be right to leave her at home if she genuinely believed she was in trouble and no matter who they are, if a patient with minor difficulties shows some understanding of the difference between that and an emergency, we feel less abused.

My shift ended with a call an hour from going home time for a tall, gangly 40 year-old Somali man ‘fitting on a bus’. He was lying face down in the aisle and a witness told me that he had been kicking his feet around. Hardly a seizure and more likely to cause me harm if he decided to do it again while I was hovering over him. In I went then, to wake him up, and it took a lot of shaking and shouting to convince him to open his eyes. I was, of course, very wary about his movements after my recent experience, but he seemed passive enough and you can usually tell if you’re in danger in the first few seconds.

I got him to sit up and then, with the help of the bus driver (which was unusual), he was put on a seat so that I could carry out my obs and continue my questions.

I got nothing out of him for a while and all of his obs were fine, except for his racing pulse, so I asked him about alcohol and drugs.

‘Have you been drinking tonight?’

He nods and grumbles something.

‘Have you taken any drugs?’

Again, he nods.


He nods.

I wasn’t really convinced because he really didn’t look the type and I was happy to believe he was just drunk. He had a huge chunk of his right cranium missing and the indentation was very pronounced, so I assumed he had suffered some kind of war injury, accident or had been operated on. It was possible his brain wasn’t intact and that he had, indeed, had a fit.

When the crew arrived, and after ten minutes on oxygen, he became more responsive and confirmed that he had just been drinking – no drugs. He had downed ten bottles of Guinness and that was a surprise. What was a Somali Muslim man doing drinking Guinness? Drinking at all, in fact?

He was taken to the land of the free (healthcare) for his own good.

Be safe.

Thursday, 17 April 2008


Eight emergencies – two false alarms, one declined and five by ambulance.

Cancer is a horrible thing; my father died of lung cancer and the end stage is perhaps the most awful part of it – watching a decline that you can’t stop. My first patient, an 86 year-old lady with lung cancer was in severe respiratory distress when I arrived at her flat. He husband and son were present and both had a haunted, surrendered look about them. All they wished for was that she didn’t suffer in her last hours or days.

She was pulling in little air whilst battling to make every breath count, yet she insisted that she didn’t want to go to hospital. I nebulised her and it brought instant relief but I knew that it would be short lived and as soon as the mask was removed, she would get bad again.

I stayed with her for a while until a crew turned up and the family were still saying that they’d rather she was at home but as I sat in the car doing my paperwork, she was brought out in a hurry, vomiting and with the DIB I’d seen when I first saw her. She was helpless and without written instructions to the contrary, she had to go to hospital. I doubted she’d see the outside world again and it was a sad thing to witness.

My father died at home with all of us around him; we all got to say goodbye and I was too young to realise the impact of it all but this job reminds me again and again of the fragility of life and the uselessness of State care when it comes to this – I’d rather die at home than in a ward.

A call for a 45 year-old disabled man who was fitting took me to an underground station where none of the staff knew what was going on – they hadn’t called us. Then I saw a familiar face, a homeless man, hobbling about on a stick. I knew he was the patient. He’d called many times tonight, according to the crew who showed up a few minutes after me. He didn’t really want our help – he just wanted to tell us how ill he was all the time.

A MOP offered him a cigarette for some bizarre reason and he favoured that over any help I could offer him, so he was left to it on scene – he wasn’t interested any more. Another few hundred tax quid down the drain.

A 28 year-old unconscious drug overdose in a hostel next and I found myself chasing him around the building. He was a tall, skinny man who’d just taken heroin and cocaine (brown and white) and believed he lived there. He didn’t.

The police were called to help corral him and in the end he was allowed to go to his rightful place of abode; another hostel somewhere nearby. Again, he had no interest in being saved but he did shake my hand and thank me for turning up.

Then a strange call to a 61 year-old with chest pain. It was pouring with rain and as I pulled up outside his building, I could see him watching me from his window. I got buzzed in and he led me into his front room, where he shouted his problems at me. He was a big, tattooed Welshman and his left knuckled bore the word HATE, so I immediately felt secure. There were a couple of knives laid out on his window ledge, as well as a pair of toenail clippers – I had to assume he used all of them for his nasty feet but it didn’t make me feel any safer.

I asked him about his medicines and he stormed into the hallway, despite my requests for him to sit still (he allegedly had chest pain remember) and he told me to follow him into a back room. This, I wasn’t sure about at all but I kept a distance just in case. The room was his kitchen and he opened a drawer to reveal a carefully stocked drugs storage area for all his meds. There were lots of them – too many.

The crew arrived and continued the conversation that I had started about going to hospital. He had refused and an ECG was carried out in his front room instead. My colleague took off his fleece and laid it down, noticing, as I did, a red LAS blanket on a chair. He had kept it as a souvenir, I thought.

I left as the crew continued to persuade him to go to hospital but then my colleague, who’d been attending, came out and asked me if I’d taken his fleece by mistake. I told him I hadn’t then it dawned on me that maybe Mr. Angry Welshman was a collector.

My colleague went back up to check the flat for his fleece but could only look in certain areas because he couldn’t prove it was there at all, even though he had definitely taken it off in that room. The man hadn’t moved anywhere but the fleece had disappeared into thin air. There wasn’t much else we could do, apart from make accusations that couldn’t be upheld, so the crew had to go without it…and without the patient because he refused to go and as I left, I watched him place the red blanket over something on his chair…probably a green LAS fleece.

A call for an unknown male ‘collapsed outside tube station, blood seen’, took me to Theatreland and I found the middle-aged man on the ground making strange noises as he drifted in and out of consciousness. He had been drinking but not much, according to his lady friend and had complained of ‘feeling strange’ all night. The blood was coming from a head wound he’d received when he fell to the pavement.

Night workmen around the station had helped all they could before I got there and I spent almost half an hour with him, keeping him awake on oxygen, before an ambulance arrived. As soon as he was moved he began to vomit acidic red stuff – not blood, food and red wine I think, but it smelled very bad indeed and burned the inside of my nostrils.

He was taken to the ambulance and off to hospital, a little more aware by the time he’d been transferred to the vehicle. I thought he might have had a neurological event but I heard later that he’d simply had too much alcohol. Apparently he’d been drinking long before he met up with his friend.

I think I’ve said this before…never ever abandon your drunken friend in a public place, even if he’s a pain in the neck. An inebriated 25 year-old man was dumped in Covent Garden by his so-called mates and I was called to help him. He was vomiting and helpless. He’d clung around the legs of a club doorman asking for an ambulance until he’d conceded, so off he went to hospital. Thanks, guys.

I wasn’t required for a 45 year-old with chest pain at a police station; the crew were on scene with me and another pair of hands was unlikely to be needed because most of these calls are from scared prisoners who just don’t want to be there.

My last call of the night came in the early hours, after a lull of about three hours. He was a 62 year-old COPD patient with severe DIB and it was genuine enough for me to put him on a nebuliser immediately, even though the crew were on scene a few seconds after me. He recovered a little on this and by the time he was in the ambulance, he looked a lot healthier, if that can be said of someone with a chronic breathing condition.

Be safe.

Sunday, 13 April 2008

Marathon man

Two emergency calls; both conveyed by ambulance.

I was working on a Forward Incident Team (FIT) today, covering the London Marathon. It’s the first time I’ve been on duty for this and it was an honour to be there and watch those amazing people complete the gruelling 26.2 mile course. I used to cover the big football matches up at the old Highbury stadium, so I had some experience of large-scale cover like this. It’s a completely different way of working.

I was assigned to an ambulance with two EMT’s; usually one LAS bod is assigned with a team from the St. John Ambulance but not this year – I was working with colleagues and we had to cover the 6-mile marker before moving up to the 25-mile marker around Parliament Square.

Our first call was to a 24 year-old man who had reached the 24th mile and collapsed because his leg was so painful. From what he told me and our examination of his limb, he had suffered a stress fracture to his tibia and wouldn’t be completing the last few miles to glory...and his medal. I felt sorry for him; it must be very hard to have run that far just to be beaten, almost at the finish line, by an injury. He’d tried bravely to continue and had suffered for miles by all accounts but it was the end of the line now and off he went to hospital.

The second patient had collapsed at the same point as the last; he had gone down suddenly and felt very sick. His BP was low and he looked incredibly pale. We waited for a SJA vehicle and were close to taking him to hospital ourselves when one turned up. There were four people onboard – a ‘cardiac team’ they told me – headed by a doctor. The medic just stood over the man and asked questions – no examination was carried out and it took a while for the chair I had requested to be brought to him. He’d already spent almost 30 minutes shivering on the ground and we thought it best if he was taken into the warmth straight away but for some reason, the doctor thought better of it and seemed less than enthusiastic about caring for him. I should stress that I have worked with many incredible doctors but in the past few days, I have seen some pretty unprofessional behaviour.

Eventually, the man was taken to hospital by SJA, although how they all fitted inside the ambulance was beyond me.

Watching the Marathon made me consider doing it myself one year. I have huge admiration for everyone who did it and for the causes they were supporting in such a magnificent way. The costumes were elaborate and often heavy looking but the weather remained cool, so dehydration and exhaustion was limited to a few.

Water bottles were flying all over the place as runners picked them from the hands of the volunteers lining each marker, drank a few sips and then chucked them to the ground, splashing all of us. Eventually, there were hundreds of plastic bottles in the gutter and on the pavement, many of which contained almost all of the liquid, which I thought was a bit of a waste. We need a greener solution, I think.

A cyclist, who had nothing to do with the run, sped by on the road and had to be chased down and stopped before he caused chaos. Some people just don’t think – it was clear the road was shut but it didn’t concern him.

There were also a number of ‘unofficial’ runners taking part just for the hell of it – hats off to them too!

As the day ended and we watched the last stragglers coming in towards the finish line, I saw a blind runner being led by a friend to complete the run – a humbling thing to witness.

Then, of course, there’s Buster, reportedly 101 years-old and his first Marathon. He hadn't yet finished the run when we were stood down; it took him ten hours and the controversy that followed blighted what was still an amazing achievement for someone his age. I go to houses where people forty years or more younger than him can barely stand up, so I’m impressed, even if he isn’t quite as old as he says. Well done Buster.

Be safe.

Saturday, 12 April 2008

Kicked before breakfast

Eight calls; one arrested, one left in police custody and six by ambulance.

An early call for a 67 year-old man who’d been run over by a van and I was speeding towards the little street in Soho thinking about how bad it might be...or that it was nonsense. I arrived to find a couple of Chinese men standing over an elderly gentleman, who was lying on the road with his trouser legs rolled up. He didn’t seem to be in any pain and the Chinese men weren’t particularly fussed about the situation; one of them was still on the phone to our 999 Control and I had to ask him repeatedly what had happened.

The man on the ground was an Italian barber shop owner who was on his way to work. As he crossed the road, the van (above), driven by the two Chinese men, knocked him down as it reversed. It continued over his body as he shouted and struggled to get out from underneath. The axle and exhaust made contact with his knees and he had grazes and burns to them. He also had superficial burns to his hands, which had made contact with hot parts of the vehicle as he tried to save himself.

It took ten minutes to get the story straight because the Chinese men were completely unaware that they’d hit him and the Italian man was too angry and upset to communicate the incident clearly. By the time I had it sorted, the police and a crew had arrived and the mechanism for injury changed from minor to possibly not so minor – so he was collared and boarded as a precaution.

I got assaulted a little earlier in my shift than I’m used to and I was in no mood to take a booting from anyone, particularly a stupid drunken Ethiopian. He was asleep (or ‘unconscious’ if you want the bus driver’s universal phrase) on a bendy bus and I found him in the middle of the floor, sprawled in the aisle. At first he was difficult to rouse then he opened his eyes as I badgered him to wake up and get off the vehicle. He gave me a long hateful stare and I knew immediately that I was dealing with someone who was potentially violent – it was that kind of look. I had to get him off the bus quickly and peacefully if possible. Usually the police are called for these jobs but not this morning.

He became verbally abusive and shoved me a few times but that’s par for the course, so I let it go and continued to be the cool professional I’m supposed to be, even in the face of this rubbish. I told the bus driver to stay away from him and I called Control for police backup to help me remove him. I asked them to warn the crew that he was aggressive.

I went back and tried again with him and this time he moved a lot quicker than before. He snapped awake and shuffled himself to the doorway of the bus, allowing his legs to dangle over the edge of the floor. He swore at me a number of times and I continued to insist that he leave the bus. This annoyed him and he lashed out with his feet, without warning, kicking me in the stomach with some force. As I said, I wasn’t in the mood and much as I’d love to have stepped back, smile and apologise for being in his way (like a true professional), I didn’t because it’s not me at all. I used reasonable force to restrain him – I launched my body weight onto him and pinned his arms to his chest, all the while warning him that he wasn’t going to get away with that again. He looked shocked.

As I told him to calm down and prepared to let him go again (without being absolutely sure of his reprisal plans), the police arrived. They talked to him and tried to persuade him to get off the bus too but he was stubborn and aggressive towards them as well – he had to be thrown to the ground at one point as they tried to assist him to the ambulance, which had just pulled up. Understandably, the crew weren’t overly eager to have him but he would still need to be checked out. I wouldn’t want to find that he was a diabetic and I had over-reacted.

Inside the ambulance and even with the police present, he attacked the crew and I saw him land with a loud thud onto the floor as the officer restrained him yet again. Oh, and he wasn’t having any diabetic problems – he was just drunk and disorderly and possibly one of the most hateful ‘guests’ to our country I’ve ever come across.

He was arrested and taken (by ambulance for speed) to the police station. They knew him there; he was notorious for drunkenness and violence. Not the best start to the day for me and I spent an hour getting back up to speed.

A 20 year-old tourist having an ‘allergic reaction’ to food was suffering the effects of a stomach virus, I think. She had a high temperature, nausea and stomach cramps. She misunderstood her symptoms and associated the illness with something she’d eaten. This had the Gallery staff a bit nervous and I reassured them that nothing she’d eaten there had caused this because she’d had these symptoms for a few days now. Her older sister was with her and, to be honest, I thought she was her mother. Luckily I didn’t try any complimentary jokes.

I was back at the police station where my violent bus buddy had been taken for a 29 year-old man who had a low BM and was behaving abnormally, according to the police doctor (FME) on scene. The doc thought the man may have taken drugs because he was uncommunicative and confused. I looked at the patient out in the custody area and carried out a few obs. His BM was fine and he spoke to me without too much difficulty. He was a tall, thin Somali man and he sat on the bench in the custody room, looking depressed. He had been arrested for being drunk and disorderly and he freely admitted drinking an entire bottle of vodka but denied any drug taking. I believed him.

‘Do you have any medical problems?’ I asked him.

‘Yes, I’m homeless’, he replied with sad eyes.

I felt instantly sorry for him and I think that was because I believed him. He wasn’t trying it on and he looked genuinely lost. I continued to talk to him until the crew arrived and I promised that I would do something to get him off the streets. We work closely with an organisation called London Street Rescue – we can refer vulnerable people to them and they will get them off the street and into safe, secure accommodation. To date, we have referred dozens, perhaps hundreds of individuals.

He was so grateful that he started to cry. I’ve never seen a grown man cry in a police custody area before and it made me feel even sorrier for him.

I spoke to the doctor and told him what I’d found. He walked out of his surgery and spoke to the man himself. I had asked if he could go to hospital because he was vulnerable but because he had been arrested, the doctor would have to make a clinical decision about whether he needed to go or not. I really thought that he’d asked me to come down so that he could get the man to hospital; I thought that was actually the plan. Instead, he coldly stared down at the young man and barked commands at him, ordering him to stand up and walk forward, so that he could test his coordination and GCS. Now I knew why he had become a mute – if he’d been treated like that by a medical professional as soon as he arrived in the place, it was no wonder he had become reluctant to communicate.

Then the FME said ‘he can stay here’. I thought it was a heartless decision and wholly at odds with the intentions I thought existed. Now it would be much harder for me to get help for him because the link workers don’t go to police stations; they visit people in the street or in hospital. By the time I’d got through to them, he’d be out of jail and lost on the streets somewhere. I would be yet another uniformed pereson who'd lied to him. If it continued, he may become the type of man who attacks uniforms without warning.

Drug addicts have lots of tricks for getting the fix they crave and one of them is to call an ambulance for a fictitious pain and hope that morphine is administered, either by an inexperienced paramedic or junior doctor. My 47 year-old patient complained of such severe back pain that he couldn’t even walk to the toilet down the corridor in his hostel. He told me he’d pee’d in the sink in his room as a result. Not only did I find that disgusting but I also knew he was lying because he moved around quite well during his conversation with me, he even dressed himself fully as he explained his agony to me. He wasn’t aware of this because he was lying so automatically that he clean forget to act the part.

He hadn’t taken heroin for a few days, he told me, and the pain had kicked in during the night. If he had any pain, it was most likely part of his withdrawal, I reasoned. I wasn’t happy to take this man to hospital because nothing about him was true but the crew were downstairs and about to lug a chair and all their equipment up because the call had originally come in as ‘unconscious male’. It had been deliberately elaborated in order to get an emergency response.

‘Can’t you just give me something for the pain?’ he asked, ‘the last time I went because of this, they put a needle into me and gave me something, I’m not sure what, and it helped a lot but they made me wait an hour at hospital, so I just left.’

In other words, he had has fix and scarpered. His story about not knowing what they gave him was supposed to lull me into thinking he knew nothing about drugs. This is a guy who uses class A drugs almost every day; he’s an expert!

I asked him to try walking and I chatted to him as he went, making him forget what he was doing. Without knowing it, he walked along the corridor and all the way down three flights of steps without a single spasm. He was such a bad liar that he just couldn’t get his body to comply with the fraud.

The crew met us on the ground floor and I explained the situation – they understood and took him away. He’ll get no morphine from us, that’s for sure.

A crew arrived just ahead of me for my call to a 25 year-old man who’d collapsed in a restaurant. The report stated that he’d taken cocaine and ecstasy the night before, so I already had no sympathy for him, which was irrelevant because I didn’t have to treat him.

Again, myself and the crew assigned to a 60 year-old male with chest pain at a Boots’ store were beaten by the MRU, who’d not only turned up before us but he’d gone to the correct address. There are a number of Boots’ chemists in Oxford Street; two of them are so close together on the same side of the road that it’s easy to land at the wrong one – I’ve done it myself. This time, I wasn’t convinced of the branch we’d stopped at, so I told the crew when they jumped out. I waited and sure enough, we had to travel another hundred yards down the road. The bike was parked outside.

A family of London visitors called us to the aid of a 50 year-old drunken Lithuanian man, who’d fallen (not for the first time judging my his scarred head) and cut his scalp open on the pavement. They took him out of the rain and supported him until I arrived. One of them windmilled me to the spot where he sat, fully conscious and unwilling to receive help.

I thanked the family as I talked to him and twice persuaded him to sit down again when he decided to get up and walk; (stagger and fall). The crew recognised him – he’d been admitted to hospital earlier – he just wasn’t capable of walking around, so he went for his second visit that day.

I went home after my shift wondering how bad things would have to get before I decided the job was just too dangerous to continue. I think if a weapon is used against me, I’d reconsider my options.

Be safe.

Friday, 11 April 2008

Burning man

Nine emergencies – all went by ambulance (but not all deserved to).

It was busy today from the outset. Some days are just non-stop for no reason. The traffic was abominable, mostly due to the fact that the junction of Whitehall and Parliament Square was dug up, closing down two of the three lanes. In rush hour, this caused tail-backs that stretched right up to the Strand and every road in every direction from the Square itself. Other holes were being dug – even holes that had been dug months ago. Why do they do that? Surely once you’ve dug the hole and done the work, it’s finished.

I guess it’s about money – one contractor digs a hole to do something (water pipes), then another re-digs for electricity or phone or fun…everyone gets paid to cause misery on the roads and slow down the emergency services.

A two year-old boy was having a convulsion but the crew and I couldn’t locate the address because the mother kept changing the location details. We drove up and down the same road, passing the address several times, looking for a house name that was wrong, then a junction that was inaccurate, then a landmark that was irrelevant until, finally, she gave enough information for us to find her.

She’d been panicking and couldn’t get her facts in order during the call – she’d even told us that the child was unconscious but he wasn’t; he was lying of the floor of the flat, staring at us all as we entered. He had been convulsing earlier because he had a high temperature. She’d given him Calpol for it and now he was quiet but alert.

He was taken to hospital for checks and I went back towards my own area. Before I got there, I was asked to go and assist another FRU pilot who was alone with a combative 40 year-old who’d had a fit in the street. I’m always happy to assist colleagues in this way and so I sped off to back him up.

He was standing in the busy road with the man, who was refusing to cooperate with any of the obs my colleague was trying to carry out. He clearly didn’t know he had been fitting and was still confused but he wasn’t aggressive and he didn’t look like a threat – he was just a little agitated. It was still better to have two pairs of hands on scene, however, because he needed to be balanced on his feet.

The ambulance arrived a few minutes later and we persuaded him to go with the crew to hospital. He was beginning to realise what had happened and thought better of arguing the point now.

Another person was fitting at Trafalgar Square, this time a 40 year-old female had collapsed suddenly, falling onto her face in front of her alcoholic friends. She was very combative and a crew and police officers were on scene already. I helped them get her onto the ambulance but did nothing more than that.

Then I raced to a high security location for a 36 year-old female who’d collapsed but it took so long for the armed officer to clear the gates for me that the ambulance arrived and I became surplus to requirements.

A cup of coffee later and a call for a 39 year-old man with burns to his hands after he’d come into contact with an unknown chemical when he’d touched a door handle. This seemed bizarre and I asked for more information. As I drove towards the scene, I was updated and told that he now had burns to his face because he’d touched it. I asked for the HART team to attend, so that I could get expert help if there was a dodgy substance involved and when I got on scene, I was taken to the large kitchen of the building.

A man sat in a chair in the kitchen’s office, colleagues around him, with red, swollen eyelids, a puffy face and blistered, cracked hands. It looked like an allergic reaction but he assured me that his hands and face were burning and that it started when he touched a door handle. He also denied any allergies or similar events, so I had to go with it as it was.

I applied watergel to his hand and face (giving him a little mask with eye-holes) and covered both hands with clean plastic bags to protect them. He now looked like an alien.

I was concerned about the fact that a chemical may be lurking around which could cause burns to other people, so I waited for HART to show up so that I could have the place checked out but they didn’t come. Instead an ambulance crew arrived and they told me HART had been cancelled because it was felt there was no need for them. Somewhere along the line, my communication about having them deployed had gone awry.

We walked the man to the street and into the ambulance. The crew decided to take him immediately to a specialist burns unit – despite the mask and gloves I’d given him, the redness and blistering appeared to be spreading to his arms (which he’d touched).

I waited for the HART team because I requested them again and two paramedics turned up from the unit to check for incriminating evidence. They went through the rubbish that the burned man had been handling and found an Acetone container – this was the only thing that could explain his injuries but he’d need to have handled it directly and frequently for this to be solely to blame. It was a mystery.

A 50 year-old man was vomiting blood in the street but I didn’t see him because the awful traffic, slowed by the rain and road works, meant it took me a little longer to get on scene. The crew, who were nearer to begin with, dealt with him.

Then a 30 year-old man who collapsed onto his settee complaining of dizziness, DIB, lack of coordination and a fast heart rate. He had a history of this and when I arrived he slumped in and out of a hyperactive display of breathing and motion. I didn’t think he was lying about his condition and it didn’t help that his mum kept supporting what he was doing but I think he was exaggerating things a bit because his vital signs, apart from a slow heart rate of below 50 at times, were all normal.

He was a fit man who played football regularly but even with that taken into account, his heart rate shouldn’t have been quite so slow all the time, so I was sure something was going on with him, I just wasn’t sure what. When he was taken to the ambulance his ECG appeared to show ventricular hypertrophy but I couldn’t nail it because his T waves gave nothing away and were mostly invisible. He did take amitriptyline for depression and this may have been a contributing factor.

After another downpour I was sent to a 65 year-old male who’d collapsed outside a tube station. He had fallen flat on his face without warning and bystanders described him as being unconscious for a time. There was no evidence of fitting in what they said.

At first, he was difficult to rouse then he became a little more aware, although not alert. His nose had been damaged, possible broken by the fall and blood was dripping out of it. I cleaned it up and put an oxygen mask on his face but that quickly became contaminated as blood leaked into it, forming a little pool at the bottom – it had to be removed.

The MRU arrived to assist me and an ambulance drew up a few minutes later. I explained the situation and we took him to the vehicle and checked him out.

‘I don’t remember falling’, he said as he began to make sense of his world.

I left the crew to it and headed for base, hoping to get away before anyone else dialled 999 in my area but, as with all my plans for early release, I received a call to a 47 year-old man who’d fallen and had a head injury. I knew the address – it was a hostel, mainly for homeless alcoholics, many of them from East Europe.

A crew had turned up alongside me and the patient was sprawled on the pavement outside the hostel. He’d fallen because he was too drunk to stand but he was completely oblivious of his injury, which amounted to a bump on the head and a bruised face.

He was Polish and spoke no English. His alcoholic friends attempted to communicate with him but somewhere along the line they ended up having an argument in Russian, so we steered him back to the here and now by standing him up and walking him to the ambulance. He turned and waved to his mates as if he was a celebrity, then he boarded his medical taxi for the trip to free bed and healthcare land; another life saved.

Be safe.

Thursday, 10 April 2008

Chest pain

Six calls – two refused, four by ambulance.

Forty kilograms is a lot of weight to drop onto your chest and my first call was to a 57 year-old, in good health and with years of experience ‘pumping iron’ who did just that. He’d been working out, as usual, in his local gym when the Swiss ball (an inflated rubber ball used for various exercises) he was balancing on whilst lifting two ‘dumb-bell’ weights suddenly burst underneath him. He collapsed immediately and one of the bells fell onto his sternum, knocking the air out of him.

I found him lying on his side on the gym floor while all around people were getting on with their exercise routines. He had been attended to by staff members, who had covered him with towels as make-shift blankets. He was in great pain, mainly in his back and chest and any slight movement caused him to cry out.

He was a large man and the musculature of his chest may well have saved his life because a crushing weight like that can cause damage to the heart and lungs. Of course, his lung function was my first main concern and I listened carefully for the sound of air entering them, especially on his left side, where most of the pain seemed to be.

I had to wait a while for the ambulance crew because they had been sent to the wrong location, thanks to some confusion among the staff about where they were. I spent twenty minutes monitoring him but I couldn’t (daren’t) move him without other professional hands because his spine was a major consideration too.

As long as he remained conscious and breathing adequately, I could manage him without disrupting his precarious state. My first attempt at getting a cannula in so that I could administer pain relief failed because he was at such an awkward angle that access to a decent vein was difficult; I’d tried a small vein in his hand but it collapsed as soon as the needle entered it – this happens every now and then. He would have to make do with entonox (gas and air) until he was on his back.

When the crew arrived, they had already been updated about the situation and brought in everything needed to collar and board him. He’d have to be lifted out of the fire exit and there was no ramp, just three or four narrow steps but with three of us now on scene, it was achievable.

I gave him morphine before we got going and the gas helped to ease the pain while we moved him from his side to his back. Entonox has a wonderful side-effect and by the time he was moved into the ambulance, he was grinning like a Cheshire cat, even though his pain hadn’t diminished much. His breathing remained stable and air entry to his lungs seemed normal but I suspected he’d broken a couple of ribs. It could have been a lot worse.

You all know my views on some ‘care’ homes (not all, some) and I’ve posted many horror stories from them. I have many more but I can’t publish them because they are just too ridiculous to be believable and some carers will get angry because they are in denial. Like I said, not all care homes for the elderly are poor but the system we have in place, where a lot of individuals who couldn’t care less are paid to look after our most vulnerable members of society, is becoming dangerous.

My next call was to a 74 year-old who was complaining of chest pain. He’d been suffering all night and when I examined him, it was clear he had a well established chest infection – every cough rattled loudly. He wasn’t well at all and there were three care assistants in his flat doing nothing useful. They talked among themselves, moved stuff around and generally stayed away from the man they were paid to care for. He sat in his chair while I carried out my obs and put him on oxygen and none of them came over to show an interest. Even when I asked the simplest questions, like ‘Has he seen a doctor?’ I received blank looks and head shakes.

He’d been chain-smoking during his illness and this was, of course, not helping him at all. When the crew arrived to take him away, he picked up the two most essential things he would need for his trip – his cigarettes and his lighter.

Sometimes MOPs and windmills forget what they are looking for when they’re tasked to wait for an ambulance and guide us in. I walked past a young girl as she stood in the doorway of what I suspected was the location of my 20 year-old asthma attack patient. I made eye contact but it wasn’t acknowledged, so I assumed she wasn’t my guide. I continued to walk among the thronging crowd of tourists by the Thames, looking for an ill female somewhere out there.

I found nothing and called Control to request a better location but the ambulance had arrived and I could see the crew coming down the steps leading to the walkway I was on. They walked towards me and then cut right. The girl I had thought might be my windmill was my windmill. She had seen me walk past, in a bright yellow jacket and bags of equipment but, for some reason, hadn’t connected me with an ambulance. Maybe her brain was programmed to see two people as a crew but I wondered why she thought I was there at all.

The asthmatic girl was hyperventilating badly; she was jumping up and down on the chair. There’s hyperventilation and there’s I wanna be hyperventilating. I left her to the crew.

I only had to assist the crew when I got to the next call for a 25 year-old ‘not alert’ at an underground station. They had beaten me to it and were dealing with her when I arrived. I’d spent ten minutes looking for them outside the station because this was the location that was given by the caller. The crew had been wandering about too, by all accounts, and had only discovered she was inside the station, on a platform, by chance.

A 35 year-old alcoholic who was said to be ‘unconscious’ in the street, wasn’t. At first he wouldn’t talk to me, but then I asked the most important question, ‘do you want to go to hospital?’ Of course he did but he made his answer a demand and that annoyed me.

‘I want to go but you have to take me to Charing Cross’, he said.

Charing Cross hospital is miles out of my area and there was no way me or the crew were going to be treated like taxis for the benefit of someone who cared nothing about what we were and why we were there. In any case, unless we specifically have to go to a named treatment centre, he would have to go to the nearest. I told him this.

‘Well, if you don’t take me to Charing Cross, you can basically piss off’, he replied.

Another nice customer and another reminder that this country is going to the dogs.

I asked the crew not to bother when they arrived, I’d cancelled them anyway so they parked up and did their paperwork. A CRU colleague had joined me earlier and neither of us could persuade the man to comply…or be nice. He had to be moved on because he’d generate further calls from this area, so I requested police to deal with him and by chance a lone police officer in a van passed by. I flagged him down and asked for his assistance.

The drunk had crossed the road to harass a group of people standing there and the officer went over to tell the man to move on. He argued a bit and the officer, with endless patience said that he didn’t have time to argue with him because his van was blocking the road.

‘You’ll have to move it’, said the officer, referring to the fact that he wanted him to go away from the area.

‘But I can’t drive’, said the drunken fool.

Another drunk, this time with a sense of humour and no aggression, was found slumped in the street with a ‘leg injury’ that didn’t exist. Some French tourists had seen him in passing and decided that he must be in trouble, so they called an ambulance. Don’t they have drunken vagrants in France?

An ambulance, MRU and yours truly were sent to this; it was way over the top and the man sat on the ground, happily sticking his tongue out at us. At one point, he picked up a harmonica and blew into it, producing what he must have thought was a tuneful aria but what, in fact, sounded like a cat being castrated without anaesthetic (as I’d imagine that to sound, I hasten to add).

He didn’t go to hospital because he didn’t need to and he refused any assistance offered. We left him to his ‘melody’ and hoped no other tourist would walk past him should he decide that music was not enough to keep himself awake. That would suddenly be translated as ‘unconscious’ or ‘dead’.

Be safe.

Wednesday, 9 April 2008

Maybe now it's sprung...

Five emergencies; one dead at scene, the others conveyed by ambulance.

Sunshine all day today. Not too warm but hey, who's complaining?

The first call of the morning was for a 78 year-old female ‘not breathing ?suspended’. They weren’t wrong and when I arrived the crew were ahead of me. I climbed to the fourth floor (no lifts) and stood, a little out of breath, in the woman’s front room as the crew paramedic told me she was long gone.

She lay face down on her settee and the PM staining was obvious around her face, as was the rigor of her limbs when I touched them. There was no doubt here and obviously nothing for us to do but console the woman’s relative and do the necessary paperwork. I left the crew on scene as they carried out those duties and went back to my car, cancelling the incoming second ambulance crew as I did – there was no point in crowding out the flat, especially as the relative was already distraught at her sudden loss.

A call for a 30 year-old man ‘passing blood through his rectum’ led me to one of the Royal parks where two police officers stood over a homeless man as he sat on the pavement. He told me he had been passing dark coloured stools recently and I had no reason to doubt him – he was an alcoholic and liver disease, with its related health problems, is common in such individuals. He was also very cold; he sat there shivering in the morning sunshine.

I tried to get a temperature from his ears but they were so full of wax that the probe wouldn’t work for me. It can’t ‘see’ past gunk in the canal and if it can’t detect the heat from the ear-drum, it won’t give a reading, so I gave up on it and assumed that he was cold enough to warrant re-warming, even if he was known to be a frequent flyer.

On my way back through Trafalgar Square I watched in amazement as a cyclist attempted to race through a red light before noticing that the heavy traffic, which also included a good number of fellow cyclists – none of whom were about to give way to him as he began to cross their rightful path, was heading straight towards him. This caused him to think again, so he applied his brakes hard, so hard, in fact, that he flew head-long over the handlebars and landed with an undignified thud on the ground in front of the now-slowing vehicles. I waited to see if he’d need my help but he stood up immediately and walked himself and his crippled bicycle back to the pavement. He was lucky this time and I drove off wondering if he’d learned anything.

A 25 year-old female with abdominal pain at work was my next patient. She lay on the first aid room bed with her knees drawn up to ease the pain, which was quite high up in her abdomen; just below the sternum. She had no medical history for this and had never experienced this kind of pain before, which she scored at 8 (and a half) out of ten. Her sense of humour was intact, thankfully; otherwise my attempts to console through lame jokes and wise-cracks are misinterpreted or missed entirely. I choose my subjects for banter carefully these days.

She was given entonox for her pain by the crew when they arrived and off she went to hospital for a diagnosis (hopefully).

A call to a busy street in the West End for a 35 year-old male having a fit next. A CRU colleague was on scene already and seemed to have it all under control but maybe my hands could help, so I got out and got the story from him.

The patient was an epileptic with learning difficulties and he was with his parents, both of whom knew exactly how to treat him. He’d been given some of his own medicine by his mother and now everyone was waiting for him to recover fully. An off-duty doctor was also on scene and had helped out while the man had his seizure on the pavement.

He remained post ictal and somewhat combative for a while and getting a set of obs was proving difficult. When the crew arrived it took a few of us to lift him, unwillingly, onto the trolley bed and take him into the ambulance. All the while, his parents tried to reassure him but that didn’t seem to help – he became a crying bundle in the back of the vehicle – a normal part of his recovery, his mother told me. Calm, collected and thoroughly rehearsed parents are rare.

On my last call, I was told to ‘shut up!’ by a MOP who was walking on the pavement as I drove off and started my sirens (for the benefit of the traffic ahead). It irritates me when this happens (and it frequently does) – my instinct tells me to stop and ask him why he’s being so stupidly rude. I’m not the one making the noise. It’s not my fault his ears are sensitive or the siren frequency is so high and aggravating to him. Ignorant man.

I had to travel down a one-way street to get to my 16 year-old girl with DIB...remember that means difficulty in breathing; severe respiratory distress. What did I find? A teenager, sitting on a step, talking on her mobile phone to Control. I didn’t find a gasping asthmatic, as I expected, and the other detail given – that she was ‘unable to move at all’ was a myth too. She stood up and walked to the ambulance with me when it arrived. It's amazing what people will tell us when asked certain questions.

She had been given some pills by her GP and now she ‘felt funny’, without specifying what that entailed – laughter perhaps?

I got a nice long stint on stand-by in the sunshine at Traffy Square and I watched in amazement as two teenagers from Korea (they had their national badges on) showed off their football skills to the general public. It was fascinating to watch and they balanced the ball and played with it without losing it, even when they somersaulted around it as it flew into the air. Good stuff but can they play football, I thought.

I also pondered the people crawling all over the lions in the square. They do it all the time and we are frequently called to sprains, fractures and head injuries as a result of them falling’s a long way to the ground. I wondered at the irony that nobody has bothered to warn them off, even with a sign saying it was their own fault if they damaged themselves, you know, to cover any possible liability the authorities may have. Instead there are prominent signs warning people not to feed the pigeons.

So, when you visit the Square, please don’t feed the birds but by all means, feel free to fall off the lions.

Be safe.

Monday, 7 April 2008

Controversial fire

Spring has sprung...not!

Two (yep, 2) emergency calls – one false alarm and one by ambulance.

The Capital was preparing itself for the arrival of that eternal fire, the Olympic Flame, amidst a crisis in the weather. Usually, I’m on standby at Trafalgar Square in the sunshine, with mobs of tourists and Sunday Londoners milling about on a day like this at this time of year. Today, I’m in the middle of a snow storm.

Just before the flakes began to fall in earnest, I was called to a collapsed 40 year-old who’d been seen lying on the pavement ‘not responding’. When I got on scene, he was sitting up against a wall, with a can of lager by his side and a paper bag around his neck.

I parked up and my update stated that he was ‘very grey’. I saw the caller on the ‘phone to Control across the road. He would be telling them, from a safe distance, that I was there. He promptly disappeared after a few seconds; I guess he had better things to do.

As soon as I got close enough to see his face, I realised why the caller had thought he was grey – he had a whitish stain across his nose and mouth and that could only mean one thing in these circumstances; he had been inhaling a solvent. The paper bag around his neck was the biggest clue.

He’d just had his ‘hit’ and now he wasn’t talking, so I asked him if he needed an ambulance. He shook his head and looked annoyed that I would suggest such a thing. I went back to my car but I couldn’t leave him there. He was on a residential street, it was starting to snow hard and it was freezing outside. His hands had felt like blocks of ice when I touched them. He needed to go to a place of safety (and shelter). He confirmed that when, as I looked at him in my rear-view mirror, he slid from the standing position I’d put him in, to a less than refined horizontal one. He fell down.

I gave him a blanket and no option; he was going to hospital. The ambulance arrived in the white flurry and he was whisked off. He’d never appreciate this act nor thank anyone involved and he may have died in the street, cold as it was but sometimes this job is all about knowing you did the right thing and feeling better for it, if only for a short time.

I sat on Trafalgar Square as they prepared for the coming of the Olympic Torch, in a veritable blizzard. Police officers began to show up for their stint of duty there and one of them chatted to me as he hid his frozen hands inside his coat (he’d forgotten his gloves). It was going to be a miserable day for them; at least I was inside a warm car. My colleagues were out on bicycles and motorbikes in this weather too, so I sympathised with all of them. I hope you got warm eventually Sarge!

Pop music drifted over from the sound system at the column and it mixed with the church bells, ringing for Sunday service. It was beautifully eclectic and just my thing because it’s not unusual for me to have classical music playing while my sirens are on – the clash of sounds works for me.

For the rest of the day I was mobile around the areas where the torch was travelling. After a few incidents, including one in which a protestor got close enough to handle the thing, nothing much happened and very few people even got a chance to see it for real because a tight cordon of Chinese security men, police officers and riot cops protected the bearers throughout. If the flame wasn’t obscured by security, it was hidden on the top deck of a bus. It all seemed pointless. Expensive and pointless. It meant nothing to me and the symbolism was lost.

I think it’s right to demonstrate opposition openly and vocally but when the enjoyment of what was supposed to be a real symbol of sport is taken away from thousands of people just because a few protestors like to be more 'active' – even to the point of potentially harming the torch-bearers, I think we’ve reached a low point in society. Go out and shout all you want about what you disagree with but keep your hands off people and property that doesn't belong to you - it detracts from your message and removes any sympathy for your cause. I only know about Falun Gong, for example because the protestors I've seen are visible, persistent and peaceful.

Before I went home, I attended a 35 year-old man who was in the custody of the police. The cells were full of people who’d been arrested as a result of today’s protests. They’ll all have criminal records and have made no difference to anything in politics. My patient wasn’t a protestor – he was drug addict who claimed he’d overdosed on heroin. He denied this when I arrived and refused any medical attention whatsoever. He had wasted everybody’s time and was probably the only one in that cell block who truly deserved to be there.

Be safe.