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.

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