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.


Oliver Smith said...

"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.

Some people just have it tough. Strokes are horrible things. Someone I know fairly well had a stroke at work (ironically she worked in a large city hospital). Eight weeks and two operations later it is thought that she'll never regain the use of her left side from the neck down. She is only 21.

Xf said...


And they say there's a God...

Australian Web Directory said...

I don't know how you guys do it. Facing death each day. I guess the saves make up for the losses. It must be heart-twisting when kids are involved.

RSA course said...

In Australia there is a trend to having paramedics degree qualified. Is it the same in the UK?

There's also talk of passing laws to make assaulting "ambos", the same as assaulting a police officer. I think that's a good move.