Tuesday, 1 April 2008

Alcohol makes you brave

Ten emergency calls; one declined, one cancelled on scene and one cancelled en route, two taken by car and five went by ambulance.

It was a busy night and the delay in getting an ambulance for my 66 year-old patient meant that I had to carry out a 12-lead ECG in a pub – a pub cellar in fact. The woman had fainted and vomited a few times and her friends were concerned about her. By the time I arrived she was recovering and slightly embarrassed by the fuss being made but her friends were right to call us – sudden collapse, especially more than once, can often mean an underlying cardiac problem exists. She has high blood pressure and had been on antihypertensives since that diagnosis was made. She has also lost an impressive amount of weight in the past year or so and that may well have been a contributing factor to this evening’s events. I advised her to talk to her GP about her meds; they may need to be adjusted.

So, there we were, in a musty old cellar in a West End pub. We’d walked through the bemused crowds inside to get here but the staff had been very kind in allowing me to use their space. Her friends gathered around to have a laugh at her expense but they’ve known each other so long it was like being with a Hen party. They were all quite mad.

In the end, the patient declined the offer to go to hospital. Her ECG was absolutely fine and her vitals had all returned to normal, so there was no need to spoil her night any further. I advised her and her friends to call us again if they had any problems but I’m sure they just got on with their weekend.

As soon as I got on scene for a 60 year-old female who’d fainted, I was cancelled. An ambulance and FRU were already on scene and I’d made the long trip west for nothing.

I was cancelled again for the next call – a 45 year-old male in ‘? cardiac arrest’ behind the door of a toilet cubicle in a McDonald’s. I knew when I saw this description that it would probably be a drunk, a drug addict, a faint or another false alarm. It went from Red1 to Amber2 and I was to be proved correct when I received the cancellation through my MDT. He was conscious – probably had been all along. If you’re going to have a cardiac arrest, don’t have it in a toilet cubicle of a McDonald’s - we won't believe you.

A young mother was allegedly assaulted by her drunken ex-boyfriend during an argument. She was shoved against a wall while she held her one year-old baby in her arms. The baby’s head made contact with the wall and I was called to attend the injury. I couldn’t locate the block of flats at first because I didn’t know the area and, once again, in a bid to improve the image of these council fortresses, scaffolding disguised the place and its name plate was obscured. The police, who arrived on scene just as I did, also drive around in circles looking for the right place.

Eventually, we located it and the ambulance pulled up outside as I entered with the cops. Inside, a teenage mum was holding a baby who looked none the worse for wear. She explained what had happened and I examined the child for bumps to the head – there were none, so I left the crew on scene and did my paperwork in the car. I thought about this job and wondered what kind of man assaults his girlfriend (ex or not) while she’s holding their child. The assault, however benign it seemed was bad enough but to risk hurting an innocent baby...well, that takes a real man, doesn’t it?

If you are a windmill, please don’t dress in black and expect me to see you as you wave frantically at me, especially if it’s raining and the street is heavy with traffic and people. I’ll be concentrating on my driving and glancing left and right to get a bearing on where the location of the call is. I need a visible, almost in my face, windmill to help me. This call, in Covent Garden, was for a 32 year-old male who’d been found collapsed in the street. Covent Garden’s a neat and tidy place and they don’t like drunks and layabouts on the pavement, so I knew it would be a case of lifting someone up and assisting them to transient sobriety. I drove past the man and his helpers, however, because the person waving at me was a doorman, dressed completely in black. I did a complete circuit of the area and got back to where I started before seeing the ambulance pull up.

The man was drunk, of course and the crew pulled him to his feet and staggered him into the back of the ambulance. It was a litter-clearing job, as I suspected.

Then a long trip south for a man who’d been found collapsed outside a tube station. A crew were already on scene and it seemed silly that I was there at all because they had been attending to him for a while before I arrived. He was a Polish/Russian/East European alcoholic with a wedding ring on his finger (we wondered who had married him; he was ugly drunk and had soiled his trousers). He kept trying to throw his fists and grope the female EMT’s backside. Time and time again his hands had to be pulled back into his lap – he was very drunk and completely non-communicative. He either chose not to speak, he couldn’t speak or he knew no English to speak of. I choose the latter.

I went back to that tube station again for my next job. This time a 28 year-old man had a head injury after being assaulted during a scuffle outside a club. He was standing in the rain with his mates around him, one of which was stemming the flow of blood from his wounded scalp. He had a couple of decent lacerations there, so he needed to go to hospital but I’d just driven from there and I knew how many ambulance crews were tied up with other alcohol-related jobs, so there was no way I was going to get a vehicle assigned any time soon and I didn’t fancy hanging around in the area where the lad had been hit.

The police arrived and I gave them a quick report before letting them know I was going to transport the patient myself. One of his friends came with me in the car and the other accompanied the police in theirs and off we went to hospital. I booked him in and left them to it. One thing I noticed when I walked outside into the ambulance parking area; a sad indictment of the times – there were more police vehicles than ambulances parked outside.

You all know that I don’t like working in the far south; in areas where I’m just not safe on my own. When we are short of vehicles and under extreme pressure from timewasters and drunkards, I will be sent wherever they need a response, regardless of how I feel about the driving risk and potential for danger. This is one reason why the FRU secondment is not a popular one and why many people quit after one tour of duty.

I went 4 miles south to a block of flats in a messy, dark and dangerous estate for a 1 year-old boy with DIB and a high temperature. There was no crew around when I parked up and it was very quiet. In the early hours of the morning the nice people are in bed around here. The lifts were out so I had to walk up each flight of stairs in an enclosed stairwell until I guessed the right landing on which the flat existed. I got this wrong a few times and had to go back and start again in the stairwell. I’m not a nervous person by nature and I can stand my ground but, like anyone else with sense, I don’t like being cornered or not knowing what’s around the next bend, so every step up in that dank concrete hell-hole was step into a dark unknown. There was plenty of evidence of drug abuse in the place.

I got to the right landing and walked up to the door. I knocked. Then I knocked again...and again. I was knocking so loud now that the neighbours must have heard me, although nobody came out. All was quiet and very dark. I was on the seventh floor and I couldn’t see much of what lay below me when I looked over the balcony.

I called Control and, after a frustrating two minutes of hearing engaged tones, I eventually got through (I’m really stuffed if I ever get into trouble when we are busy like this). They tried to call back the origin and confirmed with me that I was at the correct block of flats and outside the correct address. It seemed strange that nobody was home and I began to feel uncomfortable about it but I waited and stood off at a distance from the door - just in case some nutter with a plan came at me from inside; I was a bit paranoid I think; sometimes the night shift can do that to you. It messes with your head.

Then I received a call back telling me that the patient’s family were with the crew. I hadn’t seen anyone. Nobody had passed me and nobody had tried to get my attention. There I was standing at the top of this miserable windswept and uninteresting complex, with nowhere to escape to if anyone decided to have a go and the patient had flown the coop. I wasn’t happy.

'Get out of there', the voice on the other end of my phone told me. I know he was concerned about my position but he hardly instilled confidence because he said it in the tone of voice that intimated he knew something I didn't. You know, that 'the killer's in the house...get out of there now!' kind of scenario.

So, I made my way back down those miserable, urine-stained stairs until I found terra firma again. The patient and the family were inside a warm, safe ambulance. The child had a cough and a wheeze and was being nebulised. The mother told me she had come down another way because...

‘The lifts aren’t working, you know’

‘I know’, I said, ‘I have experience with your stairwell.’

I left them to it and got myself back to normal while I did my paperwork. I was clearly in the middle of a stressful night and it was beginning to affect me.

My next pleasant job was for a 35 year-old man who was unconscious outside a pub near Tower Bridge. I shot past the place because the lights were out (it was 4am) and the windmills, once again, were dressed in dark clothes. I found it a few minutes later when I spun round and retraced my route. Two very loud and very Cockney women were standing over a slumped figure. They knew him but not well enough to give me more than his first name. He was against the wall of the pub and, as one of the women bellowed out for the landlord to come and see, I checked him out. He was drunk and he had pinpoint pupils. I thought he might have taken something, so after checking his BM and putting him on oxygen, I prepared to cannulate him for a shot of Narcan.

‘He’s ‘ad drugs!’ one of the interested loud women shouted to nobody in particular. What exactly do these people do all night? I thought to myself. It’s a sub-society.

I didn’t know if he’d taken Heroin or not but giving Narcan is a fairly good way of finding out - it was academic, however, because he began to stir and wake up when the needle went into his skin. He pulled the cannula out and I stopped his bleeding before he made things worse. Then he struggled to his knees, completely ignoring everything I said. Meanwhile, the ambulance shot past, just as I had done and ventured too far up the road...just as I had done. Two pairs of eyes made no difference on this call apparently.

The man stabilised himself as if he was going to pray. He fumbled around the front of himself and I wondered what he was doing. Then he pulled out his penis and began to urinate, whilst kneeling, onto the pavement (and his trousers) – mainly his trousers. Oh, so that’s what he was doing, I thought. I moved back five feet or so to avoid any splashes from his intoxicated targeting and the crew pulled up as he completed his mission. Then I handed him over to them without delay and I didn’t stick around for much longer. I was tired and wet and now I smelled of urine because he had hit me with a couple of salvos at the beginning and I hadn’t seen them coming.

I went back to my station to clean up and grab a cup of coffee. I deserved it.

Then out to a male who’d been assaulted. I arrived to find the crew on scene and police around. I went to the ambulance as they loaded the man inside. He’d been involved in an argument in a club with another man. It had escalated and spilled out onto the street where it was quickly and violently settled...with a baseball bat. The patient had a serious head injury but was conscious, although witnesses, including his girlfriend, said that he hit the ground so hard he may have been knocked unconscious for a short time – he hadn’t moved at all when he fell.

As the crew were treating him, he vomited a lot of blood onto the floor of the ambulance – this happened repeatedly and it was clear that he either had another injury, possibly to his abdomen, or he had swallowed a massive amount of blood from his head injury, which would indicate a significant intracranial bleed. He had been hit on the face, the bat making contact with his nose and forehead, so it was likely a downward blow onto his skull – the mechanism for a fractured cranial vault; his nose may also have been impacted so hard that the energy crossed into the basal skull and damaged the cribriform plate that lies above his nose. The term used for such an injury is frontobasal fracture and I haven’t seen many of them.

I stepped into the ambulance to help and a young girl opened the door without invitation. She was extremely drunk and could barely focus – I don’t think she even knew where she was. I asked her to go away but she gave me that fish-eyed look that stupidly drunk people have and I had to prise the door from her fingers. She had absolutely nothing to do with the patient inside, so I closed the door on her. As I did, she staggered backwards and fell to the ground. She went down, legs akimbo, and there was a gasp of horror from the rest of the drunken mob around her. I quickly checked that she was okay and continued to close the door – we had more important business inside.

As he was being settled in for the emergency trip to hospital, I was asked to attend to a member of staff at the same club who’d just been bitten by another drunken punter. His finger had been torn through, almost to the bone and was bleeding heavily. I put a pressure dressing on it and called it in. He would come with me in the car to hospital.

I had two questions about this call. Firstly, how on earth do you smuggle a baseball bat inside a club when the door staff frisk everyone for weapons? Secondly, what kind of person goes out for the night armed with a potentially lethal weapon anyway? Answers on a postcard...

On second thoughts, don’t bother.

My shift ended with a long trip out to Clapham, where I don’t belong at all, for a 42 year-old woman who was vomiting blood due to a reaction she was having to her meds. Her family were around and she was leaning out of bed and into a waste-paper basket. There was little evidence of blood but her vomit seemed dark enough to warrant that description. She was on new HRT tablets and these can, unfortunately, have some uncomfortable side-effects, including heavy PV bleed. She had a history of problems with the medicines the doctor prescribed and her GP was obviously trying to get it right for her. Some people are just sensitive to everything they’re given.

The crew arrived and took charge of the patient while I completed my last PRF for the night before heading back to base and onward home, thanks to my colleague arriving promptly to take over from me.

Be safe.


JackB said...

My friends always ask me what its like living in a pub, they say how great it must be to have all that alcohol on my doorstep. I'll get them to have a look at your blog next time anyone tells me they envy me.

Chris said...

If you want to get a weapon into a club, and aren't the most innocent looking person in the world, do it at a big club where everyone gets searched. The more people need to be searched, the more cursory the search.

(Said as an ex, and soon to be, member of security staff at a nightclub)

Cheating Death said...

Doesn't the booze make you do things you couldn't normally!