Tuesday, 27 May 2008

Baby bingers

Ten calls; one time waster, one assisted-only and eight by ambulance.

Binge drinking by the under 16’s is on the rise and we are going to more and more calls for 10, 11 and 12 year-old offenders. Now, I know this is a ‘hot topic’ and personally I blame the parents for this too but the main issue is the serious health problems that will ensue if we don’t put a stop to it. We simply don’t know how young livers cope with alcohol in the quantities (and more) that an adult would drink on a binge.

I sat in EOC (our control centre) as I waited to see a friend and listened in on the 999 calls at the HEMS/MRU/CRU desk. As I waited and listened, a call came in for an 11 year-old who’d been found drunk. Later, while out on the road, I heard another FRU pilot say he was going to a 13 year-old drunk. I have personally treated many young drunks over the years and I remember three 13 year-olds unconscious on a park bench after an all-day drinking session. It was broad daylight.

Most of us tried alcohol when we were young, so that’s not the bone of contention; its ease of access and the obvious lack of control of some parents that’s mostly to blame. At 4am, I watched three young girls – probably no older than 12 or 13 years-old – walking past the station on their way to or from God knows where. Are their parents mad? London is a dangerous place for grown-ups at this time of day, never mind kids.

I had an observer – Olivia - out of EOC with me tonight for a few hours. It was good to have her company and we get on well anyway, so she was someone to talk to as well as being a good second pair of hands.

The night started with a 54 year-old man who’d fallen from his mobility scooter earlier and was now complaining of back and abdomen pain. He’d already been seen at hospital and his x-rays were clear but we were called out again because his carer was convinced he was deteriorating. It took a few minutes but, after a full examination, I found out that he was just too scared to stay at home in his vulnerable state. In the recent past he’d been robbed when a gang of youths, male and female, broke into his house while he was inside and threatened him. Nice neighbourhood, I thought, as he tearfully related his story, backed up by his obviously caring carer.

He was taken to hospital but I’m sure his physical problems were exacerbated by his stress. Somebody somewhere needs to do more to protect these people.


I thought the man lying flat on his back at a busy bus stop was in cardiac arrest as I got out of the car and went towards him. The 35 year-old lay motionless after suddenly collapsing in the street. Bystanders were tending to him and as I closed in, I could see that he was breathing, thankfully. I shook him awake in time-honoured fashion because, at close quarters, I could tell he was drunk.

The ambulance crew was on scene at the same time and they arrived to pick him up and take him away, after he’d opened his eyes and admitted drinking a lot.


The address of my next patient seemed almost impossibly elusive. We were in the right place but the numbering of the flats seemed completely illogical and we went up and down stairs for almost five minutes trying to locate the correct door. It wasn’t until Liv separated from me and went to explore another floor (one we’d already been on) that we finally got on scene.The man inside, an 80 year-old with chest pain, wouldn’t have benefitted from this council-planned stupidity if he’d been having a genuine heart attack but, when I eventually got to him, I found that he wasn’t. He had abdominal pain and back pain. His family told me that he’d recently been diagnosed with stomach cancer and that kind of news is bound to give anyone depression - the more I spoke to him the more I was convinced he was suffering psychologically as well as physically.

He’d been ‘jerking about', according to his daughter and he displayed this for me when I got to him but it was more of an emotional reaction to discomfort than anything else and I spoke to him to calm him down. He didn’t do it again after that and lay quietly in his bed as I waited for the ambulance crew who were, coincidentally, trapped outside and as lost as I had been. I had to send Liv to get them.


Then a regular time-waster with ‘DIB’ at a police station. He didn’t have DIB and as soon as I saw him I recognised him...and he recognised me. I’ve known this man for almost five years and have met him many times in different locations. He’s the same guy I wrote about a few months ago; the one who was sitting at a bus stop across the road from the hospital. He has no medical issues but he has psychiatric problems and learning difficulties. He also has a temper and can be aggressive, so I was quiet and calm with him but I still talked to him about wasting our time, especially tonight as it was very busy.

‘Do you want to go to hospital and wait in reception?’ I asked him.

‘How long’s the waiting time?’ he replied. That said it all really. He didn’t want to wait and so I cancelled the ambulance and got the police to call someone and collect him.


A 31 year-old man who’d been beaten up recently had chest pain in Soho. His pain wasn’t cardiac in origin, I was pretty sure of that but he may have sustained damage to his ribs as a result of the beating, so he was taken to hospital.


A short drive to a restaurant in Leicester Square next for a 45 year-old diabetic man who was hypo. Those damned pedicabs were blocking the entrance to the Square, as usual, so I was held up for a few seconds more than I should have been as the restaurant manager waved frantically for me to follow him to the patient.

The man was flat on his back on the floor and his friend explained that he had become unresponsive and fitted just as they were going to have something to eat. I checked his BM and it was 1.8 – far too low. I tried Glucogel but he was difficult to manage, so he got an injection of Glucagon, followed by more gel, which he still wasn’t taking in properly. I was treating him as customers came and went, ate their meals and waitresses busied themselves around us. Liv was valuable to me on that call and she handed me everything I needed, including new gloves because Glucogel is very sticky stuff.

I stayed with him for quite a while until the ambulance arrived (as I said, we were incredibly busy) and by that time, he’d started to make some sense and his BM had improved to 3.4 but he wasn’t completely recovered yet, so he was taken to hospital – prudent considering he’d had a fit – and his condition seemed to be improving just before the ambulance left. Oh and the pizza he and his friend had ordered was delivered to the ambulance door, which I found quite bizarre.


I was on my own for the next call and the rest of the shift – a very tired Liv went home after the diabetic call. A collapsed, drunken female in Soho had to wait because as soon as I got on scene I received a message telling me there was a ‘disturbance in the area’. Sure enough, there were cops all around me and I found myself trapped by their vehicles. Shortly afterwards, a teary-eyed woman was dragged in handcuffs to the lock-up van. She’d been at the receiving end of CS gas and I was asked if I’d check to see that she was ok but the police wouldn’t let do more than actually look through the cage she was sitting in. She was highly emotional but seemed otherwise okay and it was agreed she’d be checked out properly by the Foresnic Medical Examiner (FME) at the police station.

My drunken girl was sitting further down the road with her friends and when I finally got access to the area, I advised her and her friends to get a cab home. She simply wasn’t drunk enough for hospital, which is a twisted irony.


One of the problems I face (as do my colleagues) working on the FRU on busy nights is that I will often spend a long time with patients, sometimes critically ill patients, before an ambulance is available to back me up. Britain’s booze culture is sapping our resources and so, sometimes, you find yourself running out of things to do for a patient while you wait for a free crew. This was the case for my 22 year-old patient who’d suddenly become unconscious in a pub in the East End. A charge nurse from the local hospital had called this in, so I arrived thinking that at least there was one other person inside the establishment who could manage a patient, besides me.

Unfortunately, the nurse was very drunk, very loud and very angry at times. His young friend lay on his side on the pub floor as the manager and bar staff looked on. The place was shut now and the guy had been like this for ‘about an hour’, according to the barman. The barmaid told me he’d had at least five pints but this upset the charge nurse so much that he stood up and launched an angry tirade at her, telling her to ‘shut up’. He told me that the unconscious man had only bought a pint or two. I tried to calm them down because it was getting ridiculous and the nurse had already bitten someone else’s head off for interrupting him as he handed over to me when I first arrived, so it seemed important to me that everyone stayed calm and quiet while I figured out what was wrong with this man. I sensed the delay (sometimes you can just feel it) in getting an ambulance, so I prepared for the long haul.

He was unresponsive, except to deep pain but even then he shut down again after lifting an arm to hit me a few times. He hadn’t taken any drugs and he was a ‘good boy’ who was studying law. I have no idea why that means he’s a good boy and doesn’t do drugs but I took everyone’s word for it and his pupils and breathing rate didn’t say narcotics. So I went for the only possible logical cause (he had no medical history) – booze. He was so drunk, he’d passed out for the duration. His brain had shut down in protest and his liver busied itself trying to rid his blood of excess alcohol. It takes time and his brain wasn’t going to allow him to take in any more while the process was going on.

So, I did all my obs – two or three times and I put a line in and gave him oxygen and fluids. This combination would bring him back to reality soon. I waited for an hour before I saw an ambulance crew – they’d been busy with a shooting earlier, so it was understandable that they weren’t around when I needed them. In any case, the patient was beginning to show signs of recovery and the fluid bolus woke him up as we put him onto the stretcher. By the time he was in the ambulance and I went inside to deliver my handover PRF, he was bright as a pin and laughing at his own jokes, which weren’t funny.

I was thanked by the pub staff and promised that if ever I was up that way I should pop in for free drinks anytime. I resisted the urge to say that I’d seen what the effect of that might be and I mentally declined their kind offer. Anyway, it was pouring with rain and I needed that invitation less than a warm, dry car.


Victoria station is a regular call hot-spot because lots of people get drunk and attempt to get buses home from there. My 28 year-old patient sat in a bus shelter, supported by a small group of men who’d stopped to help him when he fell flat on his face into a puddle, cutting his head open. They propped him up and held his head for him because he couldn’t do it himself, thanks to either alcohol or the head injury...or both. I think both.

Initially he was unresponsive and kept slipping down from the seat he was on. I didn’t want to lie him down in the rain, so I got the posse to continue their sterling work as I put him on oxygen and dressed his wound. The bleeding had stopped and he had a decent gash to his forehead but I knew he’d live to drink again.

The crew arrived and he was wide awake. It had been a twenty minute wait this time, so not too bad and I had everything I needed for a quick handover.


A man was seriously injured later on when he was set upon by a gang and hit about the head with fists, feet and chains. The police were on scene when I arrived and he sat in the doorway with them. His cheek bone and the orbit of his eye were both obviously fractured and his eye stood out from his head like a golf ball. He was a large famed man; about 6 feet 4 inches tall and he easily outweighed me and the police officers around him. Head injuries can produce violent behaviour, especially when combined with alcohol, so we were all very aware of the potential this guy had for damaging us, especially me as I was up front.

He thrashed about a few times and tried to rip the oxygen mask off but he was manageable and I waited no more than fifteen minutes before an ambulance pulled up and helped him to his wobbly feet. I’d dressed his wound and examined him for other injuries, especially to the neck, chest and abdomen, which may have been caused by a weapon (it’s easy to miss a stab wound when you focus on a head injury). He had no other injuries and he’ll recover in time from this one but he may need some reconstructive work done on his face.


I went home on time and the night seemed to have flown in fairly quickly, as busy ones do. The weather was miserable but I was happy enough because I’d done a few good things and had a helping hand and good company for a few hours to boot – it can be lonely out there.

Be safe.

6 comments:

Louise said...

Response vehicles waiting for ambulances is a topic we've been discussing on station today.

The Scottish Ambulance Service is currently undergoing some changes, being implemented by the new chief exec. One of these changes is to take 70 ambulances off the road and replace them with FRV's............. now anybody, with any knowledge of how the service works at ground level, can see that this is only going to result in a back log of people waiting for transport which will have a knock on effect on ORCON times as FRV's will be tied up at jobs waiting............. its not rocket science but its gonna make for an interesting couple of years! He may be saving money but it certainly won't assist in saving lives

Anonymous said...

Why do all drunks and other wasters have to go to hospital?
I'm a community paramedic and if my exam finds that they are O.K they are told that and they stay where they are!

Blippie said...

Hi Xf

I've read a few of your posts recently in which you have been attending diabetic hypos.

What are your feelings about Glucose 10%? I see you reach for the hypostop and glucagon, but wondered if there was something about the environment you work in which means you stay away from GLX?

Cheers

Blippie

cb said...

Really interesting stuff - I liked the idea of the pizza being delivered to the ambulance door..
I suppose at least time must pass quickly at work!

Xf said...

anon

I quite agree and I do leave some of them where they are but we are an emergency service that's more worried about possible litigation should a mistake be made. That's why the police won't put a drunk in a cell before calling an ambulance.

Xf said...

blippie

I use GLX whenever I need to support the use of GLU but if GLU works on its own and the patient isn't too critical, I'll leave it to carbohydrates.

As you know, GLX is pretty rapid and has to be titrated or blood sugar will shoot through the roof. I have a posting on the way which highlights the use of GLX.