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.

7 comments:

Takoda said...

My opinion of bouncers (sorry, "Door staff") has been rapidly going down recently and this seems to be just more ammunition to feed my disgust.

I recently had a call where we attended to a woman with a small scalp laceration. She'd been assaulted completely at random in the club toilets, by another woman wielding a bottle. She had been bleeding profusely in the toilets from her wound. When she approached the bouncers, she and the assailant were both thrown out of a side door for "causing trouble", into a deserted alleyway. Fortunately for her, the assailant was too drunk to continue the assault and the woman left. She was refused entry into the club to retrieve her purse but friends managed to help. They also recognised the assailant and informed the police.

When the police turned up at the club, the bouncers denied all knowledge and had cleaned up all the evidence. I'm reliably informed by the police that this is because a) if the club gets too many "incidents" recorded against it, the police will oppose their license and b) the bouncers couldn't be bothered to document the incident as is now required by the conditions of their own license.

According to our local plod, this isn't an isolated incident and in our area, bouncers are "involved" (i.e. directly or indirectly the cause of) some 80% of incidents.

Chris said...

As a nightclub first aider, and ex nightclub security, I can categorically say that about 7/8 times out of 10 (estimated figure), the person who has been assaulted was the root cause of the problem. It is therefore perfectly understandable that the door staff ejected her as well. As for not allowing her back in for her purse, no way would it ever be allowed, unless they were quiet enough to spare someone to escort her (otherwise she doesn't leave again, making the initial ejection pointless). She would always have been able to go back for it during the day, or on another night.

Normally, after an ejection, an effort will be made to prevent further problems, by at least being in the vicinity of the place they ejected to.

As regards those mentioned in the main post: Door staff cannot force ID from someone. Touching someone "inappropriately" is par for the course in many clubs, so unless they had evidence that he had given her drugs, there is little they can do. Hopefully, the guy is on CCTV somewhere.

I don't know the full story, so I'm not going to argue about things, I just wanted to point things out from the other side of the arguement. Bear in mind as well, that neither of you know the full story from the door staff's perspectives - there are a myriad of reasons why things might have happened. Whilst, from the info I have, I would have handled things differently to them, at the end of the day, I wasn't there, so will not criticise their actions.

Anonymous said...

Hi, great blog. This may seem a slightly random question, but, as a paramedic do you come into contact with dogs very often?

Xf said...

Chris

Actually, the door staff searched the guy and didn't think to get ID. They let him go because they were told by the first paramedic that they should only call the police if they felt it necessary.

Once the girl had told us she'd been given drugs by this man, it became a police matter, regardless of their opinions or perspectives.

And as for innapropriate behaviour being 'par for the course', I'm sure it is and I'm sure a few of the women experiencing it don't mind but when you grope a drunken, drugged-up female who cannot give or refuse consent, it's sexual assualt. Even the staff agreed with that because they were the ones who reported it. Not all door staff are MALE.

Xf said...

anon

It is a bit random...but yes, we do. Most of them are locked away when we get to the patient's house but some are friendly enough and are left to lick our faces while we treat their owner.

I like dogs anyway, so I have no problem with them, generally.

Chris said...

Xf,

You were there, I wasn't, so don't think I'm arguing with your opinion. If they'd been under the impression that he had given her the drugs, then you are right, they should have detained him. They should have thought to get ID. Not doing so was (hopefully) a mistake, albeit a bad one.

The point I was trying to make was that there may have been other things going on that you were unaware of. A lot of security companies work with a minimal number of staff. Hypothetically, had a big fight kicked off, for example, the door staff may have made the decision to deal with that, and allow the other guy to leave (sometimes they have to triage too!)

Regarding inappropriate behaviour, what I was trying to say is that, whilst it is sexual assault, and it is wrong, you have to turn a blind eye to less serious instances, as there is just too much of it! Obviously this is a shades of grey thing - "groping" could mean anything from a quick pinch of the behind to something just short of rape - and there are some things which shouldnever be ignored.

You said "not all door staff are MALE". not quite sure what gave you the impression that I thought they were - several of the best I have ever worked with are women.

I'm not trying to argue, just to point out that things are different from their perspective, and to try and help you see why certain things may have ended up happening/not happening

*This may have appeared several times - if it has, sorry - my PC's playing up*

Xf said...

chris

I understand your perspective and I get along very well with many members of door staff. I just think that, as a society, we turn a blind eye to far too much - that's why we're in this moral mess and I'd ask you to consider how you'd feel if it was your daughter we were talking about.

The female member of staff was extremely concerned for the girl and the guys were doing what they could to keep the man there - the club was empty; no distractions. It was just easier to let him go, I think. They wanted to go home.