Thursday, 26 June 2008

Physical abuse

If you're hoping for a quick shock at one of London's airports, tough. The defib case is empty and someone has written 'HELP' on the glass. This comment originally stated Luton Airport but this was an error and I apologise to Luton for this misinformed misprint!

Early shift: Four calls; two assisted-only, two by ambulance.

Stats: 1 emotional (? Sexual assault); 1 chest pain; 1 drug-related resulting in an assault on me; 1 drunk

Sometimes you hear a story and it doesn’t seem right. My first call of the morning was for an 18 year-old girl who had collapsed at a tube station. MOPs were tending to her when I arrived and she was feigning unconsciousness. I sent the MOPs away with a word of thanks and set about proving to her that I knew she wasn’t out cold – I told her I knew she was consious and she opened her eyes.

She’d been wandering around since her friends dumped her in the early hours of this morning because she was too drunk to handle, apparently. Now, she’s here and she has no money – her coat and bag are gone and she has a vague memory of being with someone but she doesn’t know who. Neither does she know how she got the fresh bruises on her arms. They looked like pressure marks caused by excessive gripping, like when someone grabs you hard.

She’s young, pretty and very vulnerable and I suspect there’s more to her night-time history than she’s willing or able to say, so I request the police, preferably female officers, to attend and chat to her as she’s taken to the ambulance by the crew.

She’s taken something, I’m sure of that – or at least she’s been given something or it’s been slipped into her drink because her behaviour is strange and questionable.

The police arrive (both male) and they spend a long time with her in the ambulance. I don’t know what they found out because I was gone after waiting too long to discover the outcome of their interview.

‘I’m fed up with this now’, said my 96 year-old chest pain patient. She’d been getting up in the night repeatedly for tightness in her chest and numbness in her left arm but had ignored it until she could bear it no longer. A stoical woman but now she needed to go to hospital. Her ECG showed ST elevation and I couldn’t see any P waves at all. She was ‘blued’ in straight away to a specialist cardiac centre.

The man who attacked me was a 25 year-old, six foot druggy who had settled down on a doorway in Soho. Nobody likes that, especially if you are the doorman in charge of the doorway. I could see him watching me from behind the glass as I prodded, shouted and generally harassed the man awake, warning him that he had to move on. Usually my drunken, drugged-up patients are slow and easy to predict but this guy was faster than I anticipated. He took offence to me and rose up, lashing out with his fists. He caught me twice with heavy punches which luckily didn’t penetrate my stab vest, so the impact was softened a little. I grabbed his arms before he could put any more effort or skill into his attempts at knocking me out and tried to calm him so that I could retreat to the car and call Control for police back-up.

The cops arrived as I watched him slump back into his stupor in the doorway. Meanwhile the doorman was watching too – that’s pretty much all he did.

The man verbally abused the police officers as they tried to reason with him and it took almost half an hour from start to finish before he moved on under threat of arrest. He was stoned by his own admission (on skunk) and dangerous but he was out of sight within a few seconds as he disappeared around a corner.

This man had a chip on his shoulder about the police and about ambulance personnel. ‘I’ve had problems with members of your community too’, he told me as the police stood over him. Well, I wondered why.

A life status questionable call ended my shift. The ‘dead man’ was sitting up in the street smoking a cigarette and drinking booze when the MRU got on scene shortly before I did. An ambulance also pulled up soon after and it became a bit of a joke as we chatted to him about not sleeping in such a public place. The 999 caller even came up to speak to us, explaining that she’d seen him lying in his sleeping bag, not moving and had been so worried that her conscious wouldn’t allow her to ignore it. Fair enough.

Be safe.


I'm not sure I'd want to get into the back of this private taxi!
Early shift: Nine calls; all by ambulance.

Stats: 2 DIB; 2 not alert; 2 head injury; 1 faint; 1 allergy; 1 not required

South London and the world’s ugliest tower block for my first patient, an 80 year-old woman with DIB. She’s on the 9th floor (of course) and I find myself looking up at the grey, shabby 70’s council architecture thinking that the lift will probably not be working, if indeed there was a lift.

The lady is struggling to breathe and has swollen ankles and high blood pressure – she’s suffering from congestive heart failure and needs to go to hospital. The crew arrive a short while after me and wheel her away. I get the hell out of the area before I am forced to spend the entire shift there.

Another DIB and I’m treating a 46 year-old female who’s short of breath and feeling faint. She works in the hotel that I was sent to and I’m in the bowels of it in the small staff area set aside for the domestic workers (low paid, probably illegal). Again her ankles are swelling and she tells me she has a history of this but it has yet to be diagnosed.

The crew arrive after having been harassed by the top-hat wearing doorman who insisted they couldn’t park in the driveway because it was obstructing the free flow of rich guests who needed to get as close as possible to the main entrance in their Jaguars and Bentleys, allowing him to do his job of opening their doors for them. It was ridiculous because he’d tried the same thing with me and I’d courteously declined to move or give the keys to the car up so that one of his lackeys could move it. We get the same treatment from other drivers, bus drivers and sometimes MOPs when they believe us to be an irritating obstruction. They wouldn’t dream of behaving like that if we were the police...or their mothers were dying.

A semi-conscious 45 year-old woman in another very posh hotel after that. Again, a member of staff was unwell and had fainted but this time I wasn’t harried about my parking and neither was the crew. In fact, they were all thoroughly nice.

The patient should have been taking medicine for high blood pressure but she’d been ignoring it and the result was…high blood pressure, leading to a collapse. The fact that she’d been worrying about her son who’d apparently disappeared on an exam day may have added to her stress.

Ninety five is a ripe old age to have good health and my next patient had no medical history except for slightly high blood pressure. She’d fainted in a restaurant and a doctor from a local surgery popped in to take care of her and give a hand-over when I arrived. It was her birthday today and she was celebrating with friends; perhaps she over-did it a bit. She’d had a glass or two of wine and a meal – then she collapsed. She was recovering well when I got there and all she was worrying about was that she’d spoiled the day for everyone. I was worried about her BP, which was quite low and her BM, which was quite high, so off she went to hospital with a sympathetic crew.

A regular caller – the same guy I refer to in my book; the one who attacked me with a bottle – is out of prison and back on the streets, calling ambulances regularly…daily, in fact. My screen says that a 50 year-old male has a head injury and a ‘big lump on his stomach’ - and given the area, it could only be him. This time, he’s drunk and has a head injury after falling on his face. Worried MOPs have dialled 999 and I’m with a crew as he staggers around, smiling, waving and staining everything he touches with blood.

‘I know you!’ he spits as he points at me.

‘Yes, you do’, I agree with a professional smile (I’m in a good mood).

This time there’s no menace, no bottle and no intent to do me harm. This time, he thinks I’m his best friend.

A CRU and an ambulance are already on scene and such is his infamy that they all know him. He’ll survive and be back again tomorrow…and the next day.

A ‘not alert’ 50 year-old got two minutes of my time because the crew was on scene almost behind me. She explained her near-faint to them as I left.

Calls like this are put in newspapers. A 30 year-old woman is lying in the ‘distress position’ on a treatment bed in a hair salon. She’s called an ambulance because she’s reacting to the peroxide that’s been put in her hair. She looks shiny and blonde as a result, which is nice but she’s also got a red and swollen face, so now she looks like a glamorous puffer fish and she’s not happy. In fact, she’s crying about it because she knew it would happen and had taken a couple of antihistamines in preparation for it, hoping that they would prevent the inevitable. Unfortunately, she thinks she’s overdosed and this is the reason she’s dialled 999. I explained that she hadn’t and that she’s reacting, just as she knew she would, to the chemical in her hair. I suggested she try another colour in future and I was smiling when I said it. She smiled back but it was difficult to tell if she meant it or not. Otherwise, her airway was absolutely fine.

I request a cancellation for a faint a few miles away because I’ve been approached by a man who wants me to attend to a drunk with a head injury just a few yards from where I am parked. I can’t refuse and the ambulance is still a distance away, so I go to his aid.

A police officer is propping up a man who is a worse-for-wear professional. He fell onto the ground in Leicester Square and scared the tourists. Otherwise he is harmless and quite funny to chat to – the cop’s been with him a while and they are best mates now. His head injury needs treating, so as soon as the crew arrive he’s taken to hospital with much hilarity in the back of the ambulance - it's nice to have a patient with a sense of humour.

I end the shift at my main station when I’m called out for a 36 year-old female who’s fitting in a prison van which is now parked up on a busy road. This sort of thing always makes the police nervous – they don’t want prisoners escaping from those mobile lock-ups on pretence of illness, so when I arrive there are more than a few cops around.

I’m not needed though; she’s not fitting and the crew are dealing with her. She has abdo pain and threw herself on the floor of her cell in an attempt to get the message across to the guards. They thought she was fitting because throwing yourself to the floor is similar, right?

Anyway, all the crew want from me is a blanket because they have none. I give them two and poodle off into the sunset.

Be safe.

Wednesday, 25 June 2008

Life and limb

Five emergency calls; all taken by ambulance, four of them on blue lights.

A proper working shift this one. Almost all of the calls were genuine ambulance emergencies, deserving of ‘category A’ status.

First off, a 72 year-old woman with chest pain, headache and a high BP (which was taken by a family member). She had a normal BP when I checked it but there seemed to be an element of paranoia because she wanted it checked every few minutes and worried about it. This is the problem with home diagnostics; people begin to believe they have problems when they have no idea what the numbers mean.

Although she had normal vital signs, she insisted she was very ill and so did her family. Her past medical history prompted the crew to take her to hospital.

A strange call to a 20 year-old man who was found unconscious in a doorway. I was expecting a drunken person that I’d be able to shake awake with no problems but when I arrived two MOPs were hovering over him with worried expressions. The guy had his trousers and underwear halfway down his legs and he was face-down – completely unresponsive. This seemed bizarre; there was no explanation for his indecent exposure at this time of day.

When the crew arrived I had got started with obs and when we moved him we discovered a porn magazine underneath him, although I really don’t know if there was a connection. After a short time we managed to get him to open his eyes but he wasn’t talking to us and stared ahead with a totally drugged-up look. I asked him about this and he denied it. He looked unstable to me – physically and mentally.

His ECG was abnormal and appeared to show hypertrophy and ST elevation, so I asked him (when I could wake him) if he had chest pain. He nodded and went straight back into a deep slumber.

We ‘blued’ him in and he woke up a little more in Resus. He became unco-operative and attempted to leave the bed several times. ‘Why are you doing this to me?’ he asked over and over again. Then he grinned and fell back onto the bed unconscious.

I still don’t know why he was lying in the doorway like that and why his choice of reading matter lay beneath him. I suppose he settled down there after taking something (like LSD) and the magazine was company for him.

A 49 year-old woman with DIB and ‘purple lips’ was hyperventilating and didn’t have purple lips at all. The crew were on scene after I’d travelled a long way to get there, so I turned around and went back to my own area, only to be called again to the same location, more or less.

A 30 year-old had fitted and was now ‘passed out’ according to the caller, so I contacted Control and asked if I was required. After all, epileptics pass out a lot after a seizure, so it wouldn’t necessarily be life-threatening unless he fitted several times, continually or didn’t recover consciousness. I was sure a nearer crew could deal with it but I was sent anyway.

On the way, I received a message that a crew was on scene. I thought a cancellation would come through but it didn’t and I continued. When I arrived the crew was working over a patient lying on the ground. A lot of people had gathered round and I knew from the behaviour of the crew that this wasn’t a sleeping epileptic at all – it was a cardiac arrest in the street.

The young man had been jogging and suddenly collapsed. His agonal movements had been misinterpreted as fitting and when he stopped he was simply put in the recovery position. He wasn’t breathing but nobody noticed.

I assisted the crew with CPR and began my drugs protocols. He was shocked several times by the defibrillator and this brought a few gasps from the watching MOPs. In fact, they were getting too close and we had to tell them to back off several times before the police arrived to clear the area. Traffic was slowing as cars tail-gated for a look at what was going on; it was becoming a circus.

Everything was going smoothly and the patient’s condition remained the same – VF. I asked a bystander to help with the IV fluids and he became my drip stand. I asked his name but he was so nervous that he couldn’t remember it at first.

We moved the patient into the ambulance when the second FRU showed up (I had called this in as soon as I saw what was going on and requested a second crew). I gathered the rest of my stuff and followed them into the vehicle, where I found a complete stranger giving instructions.

‘Who are you?’ I asked.

‘I’m a cardiologist’, he replied.

‘Have you got ID?’

‘Yes’. He flashed a valid NHS ID card and I said he could stay and help but during the trip to hospital I had to remind him over and over again that I was in charge of the patient. He barked orders and got generally excited about the change in the patient’s condition when, after yet another shock, he converted from VF to VT. This was encouraging but by no means absolute and sure enough, by the time we reached hospital, he was back in VF.

I’m not knocking the doctor of course but the crew and me were perfectly able to deal with the patient; we all know what to do and everyone was working in harmony. His behaviour, however well-intended, could have thrown everyone into confusion at the risk of the patient and that just wasn’t going to happen. Having said that, it was valuable to have someone with his expertise on board because it was a difficult intubation and he helped with good cricoid pressure when I needed it.

At hospital, the patient’s condition changed from VT to VF several times until they finally stabilised him and he was taken to ITU. My colleagues have been kind enough to keep me up to date with his progress and I’m told that he is still critical but had opened his eyes after almost a week.

After the handover of this patient I went to the loo (as you do) and as I wandered back from the toilet to Resus via the Major's ward I noticed a patient sitting up in bed in a cubicle. Something caught my eye and I was sure of what it was but I hovered to watch him as he guiltily hid his hand. Then I saw it…smoke. The guy had an oxygen mask on and had slipped it up to his forehead while he enjoyed a cigarette in hospital! None of the nurses even noticed until I drew their attention to it. He could have set himself and the ward alight with his stupidity.

My last call was a distance away again. This time a 39 year-old woman who’d been learning to roller blade with her husband had fallen badly and broken her arm. Both bones were shattered below her elbow and she was in agony. I gave her entonox until the crew arrived, then I supplemented that with morphine, which eased the pain a little. This was an awkward job because her arm was badly deformed and the slightest movement caused her great pain and put the limb at risk. She had a good distal pulse, so as long as we were careful her arm would survive this.

A good shift for me; 'proper' jobs and I was in and out of my bag more than usual for a single day. I went home thinking I’d helped to make a difference – especially for the young man who’d suspended in the street. He wasn’t identified for a few days afterwards, I understand. Oh and my semi-willing drip-stand, who I’d never had the chance to thank properly was called Owen. Thanks Owen!

Be safe.

Naked cyclists

Eleven calls – one cancelled en-route (among the many others I don’t bother mentioning) and ten by ambulance.

An aggressive drunken 50 year-old slumped at a bus stop had my attention first thing in the morning. The crew was on scene with me and, although MOPs and an off-duty LAS EOC bod were helping him, he became a bit of a handful when the female crew member said something to him. He shot up and went for her but my hand was on his chest and pushing him back into the bus shelter seat before I’d planned it. He thumped back onto his behind and glared at me. ‘Don’t push me’, he said with slurred anger. It took us ten more minutes to calm him down enough to be taken to hospital, where absolutely no medical treatment was required.

On their way to work, two young men sat on the top deck of a bus heading down the Strand. One of the men suddenly collapsed and started fitting, much to the deep consternation and confusion his mate. When I arrived, the patient was in the recovery position on the floor – he was post ictal after having two seizures in quick succession.

‘Are you epileptic?’ I asked him. He nodded his head.

Sometimes even best friends keep their medical problems from each other as a way of protecting themselves and retaining their sense of capability. His mate was shocked to learn that he had this condition but he obviously knew the right thing to do and I applaud him for that.

The patient was very tall and the transfer from top deck to ambulance at ground level (obviously) was awkward and dangerous for the crew but we all get plenty of training on buses and trains to equip us for such lift and carries – not that our backs care much for this expertise.

A trip to the Great Ormond Street Hospital for Sick Children (GOSH) to attend a 55 year-old member of staff with chest pain next. The hospital isn’t equipped for emergencies like this and we are often called to deal with crises of this nature. In fact, the man had abdominal pain and right arm numbness, which I couldn’t connect to be honest but then I noticed a rash on his neck. The erythemic blush spread across his throat and down onto his chest; it seemed to be getting worse as we looked at it, so I figured all of his symptoms were associated, even though he denied having allergies. There’s a first time for everything and the older you get, the more likely you are to become sensitive to something. Having said that, he also had a high temperature so an internal infection may have triggered a reactive response.

Back into the West End to deal with a 40 year-old man who was ‘fitting’ inside a café. His seizure had stopped when I arrived and a customer was trying to help him as he lay completely confused on the floor. He didn’t know where he was or who he was so his BM was checked and it was low. The crew arrived and he was given Glucagon immediately. This would need to be followed up with a carbohydrate, so I begged a free croissant from the café ladies, who were only too happy to help. I should stress that the pastry was for the patient, not me, although I was very hungry. I did share a Mars Bar with a diabetic once after he’d had his bit and I didn’t feel too guilty about that.

After a short while, he became more aware and went to the ambulance for further obs and a trip to hospital (he had been fitting after all).

Now we don’t often get calls where professionalism is tested but my next job, for a 38 year-old man with chest pain at a posh hotel threw me off course for a few seconds. I was taken up to the room by the concierge and the door was opened by a beautiful tall Eastern European woman wearing a flimsy top and nothing but underwear below; not very much underwear I hasten to add. I walked in expecting her to blush and cover up rapidly but she didn’t – she walked around and talked me through her boyfriend’s problem as he lay on his back on the bed, half naked himself. The concierge was still at the open door and looked as though he wanted to come in but patient confidentiality forced me to smile at him and say ‘thanks, I can deal with this now’. I could see the smile melt from his face as he closed the door on himself and I chuckled inside.

My patient was having chest pain after taking cocaine earlier, by his own admission. I won’t go into more detail about the movements of the young woman around me as I tried to talk to him but I had to stop and refer to her directly after a few seconds.

‘Sorry miss, what’s your name?’

She told me her name.

‘Do you think you could get dressed for me or cover up a bit more please?’

I had a friendly smile on my face so I don’t think I caused her any embarrassment - not that she seemed capable of that anyway.

She spent the next few minutes struggling to find appropriate clothing and I continued to be professional with my patient. Cocaine can cause serious problems with the heart, so I wasn’t demoting his condition, although he did keep asking me if he was going to die, which was unlikely.

When the crew arrived the girl was respectable and the man was calmer. Downstairs, the concierge had informed his mates about the fuss in the room and told me that, as far as he knew, she wasn’t an ‘escort’. I hadn’t even asked him.

Another allergic reaction in the afternoon and my 42 year-old patient was waiting for me at the local fire station, where the boys in (black?) had put her on oxygen and readied themselves for a possible cardiac arrest. She was stable, although her throat had swollen and she was concerned about that. Her breathing was fine and she could still talk – always a good sign. She had no allergies that she knew of and had just finished a Chinese meal. The bad news for her was that she did have an allergy and it had caught up with her, so off she went to hospital.

I sped up to Camden on an assist when Control relayed a message that urgent police had been called for a crew who was being attacked (presumably by a patient). When I got there the police had arrived and at least two other FRU’s were on scene. Whatever had taken place was now over so I turned around and headed back.

A call to the Globe theatre for a 67 year-old man who’d fainted was a wasted journey too because the crew was arriving as I pulled up but I bumped into an old friend from years ago. She works there now and I managed to get ten minutes of catching up done before I went back to my own area.

A 25 year-old man with a history of fainting may need specialist examination because he had no other relevant problems. Repeated faints are always suspicious and should be carefully checked, so off he went to hospital.

On the way to my next call, which was cancelled before I got to it, I drove through a ‘parade’ of semi-naked cyclist on a rally through Central London. I went contra-flow and this upset some of them but I think I had the advantage because (a) I was in a car with blue lights on, (b) fully clothed and (c) might have looked better naked on a bike than most of those I saw.

Two children to treat next; a four year-old who was badly shaken after a mirror apparently fell onto her in a shop as her mother tried on clothes and another four year-old girl who fell off her dad’s bike on Park Lane – a notoriously fast and busy road. The former, as I said, was just shaken and the latter had a minor head injury, luckily. She too was distressed but the crew was on scene as I arrived and a passing medic had stopped to help. Both children were taken to hospital.

Be safe.

Tuesday, 24 June 2008

Kiev - my second home

I'm a bit behind on posting...I have a few to write up yet but haven't had the time, so here's a commercial break...

As you know, I visited beautiful Kiev for the second time last month and had a thoroughly relaxing time. The architecture is amazing, the people are friendly (although the older folk tend not to smile much - a habit from the old Soviet days I guess) and it has become one of the most dynamically international cities of the past five years with an influx of tourists and business people from around the world.

I spent a mere two days there and I hope to spend more time in the Ukraine in future because it has a lot of secrets and finding them is part of the joy of going there.

One aspect of Kiev(ian) life I noticed that's changed is the prominence of public alcohol consumption. A lot of the youth are drinking booze in parks, in the town square and on the streets generally. These are young men and women who'd have been pressed into military service not so long ago but now, with a Western influence and a jobless economy for most of them, the culture of alcohol is rapidly taking over and it will surely end in tears.

Having said that, there's no litter, very little graffiti, no obvious trouble or violence as a result of drinking and the population still behave as a disciplined society. The church is still a strong influence for many (I got shushed once for making a noise during a service!) and there is a palpable family-orientated culture.

I think when I go back many more things will have begun to change. There are two McDonald's restaurants within shouting distance of each other in Central Kiev. I'm sure the other mega-chains are on their way and the downward spiral will begin. I still love the place though. Here are some pics...

Friday, 20 June 2008

Revenge of Mr. C!

Four emergency calls – all taken by ambulance.

I thought you’d be amused by this police car’s call-sign. I smiled at the irony when I saw it – if your brain doesn’t think like mine then you’ll miss the point.

Mr Colostomy bag is back in the area and causing havoc by having us run around in circles for him every day, as usual. Mr C. is a disgusting human being with a full colostomy bag which hangs from his open colon. He takes great delight in detaching it and displaying his innards, much to the shock of the general public who rush en-masse to dial 999 for the man with a ‘serious stomach wound; bowels hanging out’. Even before we start rolling on the call, this description gives him away every time. We all know him and he is often abusive and aggressive.

I arrived to find him slumped pathetically in a corner near the train station. There’s nothing wrong with him medically but he is in and out of hospital every day, sometimes two or three times a day. His only complaint is that his bag is full. His term for this is that ‘it’s getting worse’. Yeah, it is, worse for all of us. The stench is unbearable and this time, because I told him he wouldn’t be going to hospital, he threw the damn thing at me. Luckily, I’m faster than him and I managed to step out of the line of fire. The bag landed in the street and the contents leaked out like watery caramel. Don’t be fooled by the alluring colour…its horrible stuff and its not edible.

The crew took him away; I guess they had no choice and the bag of putrid faeces remained on the ground, a few feet from the entrance of the local McDonalds. It’s just as well the corporation don’t still use their happy clown (which I always found freaky) because the smile would be wiped from his face if he'd seen what his burger-munching customers were having to step over..

A collapsed 65 year-old cancer patient (Ca head and neck) was just a little weak. He fell down a few times and was generally unsteady on his legs but it caused panic in his household. He was receiving radiotherapy and was due for his last session, so the crew (one of two that turned up for some reason) took him to his appointment.

A member of staff at a cycle shop started fitting out of the blue and with no previous history of epilepsy, so I was sent with a crew to help him. His seizure was dying out when we arrived and he was taken to hospital for investigation. The back end of the shop looked like a cycle graveyard. The best I could come up woth was 'so, what do you sell here then?' but it was a lead balloon.

When I get a call for chest pain and the patient is younger than 20 years old, I generally don’t believe it, so my last call, for a 14 year-old with chest pain at the Tate Modern had me thinking that it was probably something else…possibly hyperventilation. She was in the medical room with her teachers and a friend and she had abdominal pain. She had no medical history, except for heartburn but even that seemed a little much for a young, fit person, so I handed her over to a double-female crew and more pertinent questions, regarding periods, were asked when all the boys (including me) had left the room.

On my way back I stumbled (if that’s possible in a car) into a running call. A man flagged me down in the belief that I was the ambulance he had called for earlier to assist with the lifting of a very heavy patient at the front of the Tate Modern’s car park. I wasn’t, I told him but I radio’d in and suggested I could help out. Control was, of course, very happy that I could because they had nothing to send anyway and it was a green call.

I almost regretted being such a helpful Stu because the man was enormous and lay on the ground after spilling out of his wheelchair as he attempted to get back into his incredibly small car. He had no use of his legs and could only help me with his upper body. I’m no giant and I knew this was going to be difficult and probably painful for me. I asked for a volunteer from the Gallery’s security and got one man to help. The others sheepishly avoided direct eye contact. I have conjunctivitis at the moment and my eyes are a bit red, so maybe they didn’t want to offend me, who knows?

Anyway, with me and one other brave fellow, we hauled the man upwards. Then we dropped him as the sheer weight defeated us. I re-arranged my spine and we tried again after a short interval (no snacks). This time we managed, with Herculean effort, to lift the poor bloke onto the edge of his wheelchair which had been tilted, in time-honoured fashion, at an angle for an easier life. Once on the chair, he was able to pull himself further back into the seat using his own arms, thankfully. Otherwise he was destined for the ground at speed and we were heading for acute back problems and seriously damaged tendons. I’m only little but I’m strong, so don’t mess!

Be safe.

Thursday, 19 June 2008

A slow shift

Four emergency calls – all taken by ambulance.

A mixed bag of complaints from a 50 year-old man experiencing palpitations. He suffered from high blood pressure, a foot infection and had a history of unexplained cardiac problems, including undiagnosed 'palpitations' which sometimes required Adenosine to bring it under control. I couldn’t do much for him pre-hospital, so he was taken in and investigated further.

Another Red1 ‘life status questionable’ call for another sleeping (drunken) street foreigner. The 40 year-old Pole wasn’t amused by the presence of the police and refused to talk to them (or us). He had a cut to his eye, probably as a result of an inebriated stumble or a fight and this had prompted a MOP to call us with a report that he had been stabbed or shot and was now slumped, probably dead, in a doorway. Although the scenario was very unlikely, we were told to stand-by at a distance. The crew and I stood-by around the corner; hardly a distance I know but we are curious people and like to be near the action.

Into a horrible housing estate and a filthy flat to investigate the illness of a 40 year-old woman who languished (yes, it is the right word in this context) in bed complaining of everything wrong, including DIB, which allowed us to award her call a Red3 and a faster response. She had no DIB and probably spoke at length without pausing for breath when she made the call but she told me she felt unwell. I felt unwell too but I wasn’t going to hospital in an ambulance. All her obs were normal (not even a raised temperature).

At least my next patient waited a week before worrying about the seriousness of her condition and calling the emergency services for help. The 26 year-old had fainted after feeling unwell for the past seven days. Her colleagues put her in the recovery position on the floor of her office. She had suffered from migraine and vomiting days before but had no significant medical history. Only when she was in the ambulance and privacy was secured did she confess, after questioning, that she’d taken drugs. Some mysteries just aren’t.

Be safe.

Wednesday, 18 June 2008

Junkie bait

Nine calls; one assisted-only, one refused and seven by ambulance.

A crew was already dealing with a 73 year-old man with angina who’d forgotten his medication and was having chest pains in the street, so I wasn’t required, thus my shift started.

Another ‘chest pain’, this time a man was found wandering the streets of south London in hospital pyjamas. He’d absconded from a secure hospital (so not very secure then) when he decided the doctors were ‘no good’ and had walked for miles to get to where a passer-by had discovered him. He had no chest pain but was clearly confused and rambling. I had spoken to him for five minutes until a crew arrived and only then did I see that he still had IV’s in situ in both arms. He’d obviously unplugged himself and left in a hurry.

Despite a bolus of IV fluids, my next patient, a 79 year old female whose blood pressure was very low after a faint, did not improve. She was at home and her friend of over 40 years was convinced she was going to die. She was ‘blued’ in to hospital with no improvement in her condition; if anything it seemed to deteriorate – clearly something was very wrong. Even in Resus the doctor couldn’t figure it out. When I went back to the hospital later on I was told that she still hadn’t improved and that she was unlikely to survive.

A Red1 ‘life status questionable’ turned out, as usual, to be nothing more than a sleeping 26 year-old man who’d made the mistake of kipping down in the middle of the Strand where nervous MOP’s were bound to agree that he was probably dead. The police were on scene as we discussed the possibility of him not sleeping there but he was fed up being disturbed wherever he lay his head and requested that the police lock him up for the night. They refused. I gave him a blanket to keep him warm and sent him round the corner to an alley where he was less likely to be designated a corpse.

We were a bit short of ambulances tonight and my next call, to a two car RTC in the middle of a very busy and dangerous junction, where the traffic lights had failed, had me trying to control a Korean man whose car had been smashed in a collision with another, as he paced around, shouted down his mobile and generally irritated the police.

The other driver was standing on the pavement, sensibly enough but the little loud man insisted on staying in the middle of the road as attempts were made to ascertain who he was, what was wrong with him and whether he needed help. I was on scene for a long time and still had no ambulance back-up, despite many requests through Control. At one point a vehicle was diverted en-route for a higher priority call, which is fair enough – probably needed for a Red1 ‘life status questionable’ on the Strand.

Meanwhile, the Korean man’s wife drove into the confusion…I mean right into the middle of the crash scene. She attempted a messy three-point turn in the area as fire-fighters cleaned up the fuel spillage and made the wrecked vehicles safe. Traffic was chaotic and dangerous around us and the world’s tallest armed police officer tried to maintain some control of it all until the regular cops showed up. The wife’s antics were causing bemusement to say the least. I think she thought it was a car park. Mr Korea was shouting down his moblile 'phone at her, presumably giving directions, yet she was only a few feet away from him, albiet in a car. She could lip-read him for Pete's sake.

After almost an hour on scene, a crew from a completely different NHS ambulance service stopped to help out and I managed to hand over both patients (the Korean man had chest pain after hitting his steering wheel on impact; the other driver had airbag-related injuries) to the crew. I imagined the stories they’d tell their colleagues back at the seaside when they ended their shift.

I had to trek a long way to get to a 45 year-old man who was allegedly fitting by the river bank. I’d been given the wrong location, as had the crew, so it took a wee while to get to our patient. He wasn’t fitting, or at least not when I got to him but he was incredibly confused about where he was and kept insisting that he was somewhere up north – and by that I don’t mean Camden. He was taken by the crew and I noticed that he had multiple scars on his arms – a tell-tale sign of self-harm and possible mental health issues.

A 21 year-old female who was ‘vomiting blood’ at home in her little third floor flat didn’t seem to be unwell at all to me and insisted that she’d see her GP in the morning, rather than wait for an ambulance. Even my offer of a lift to hospital in the car was refused. I’m sure she hadn’t vomited blood because her mouth bore no sign of the stuff, which tends to stick and discolour. ‘I washed my mouth out afterwards’, she told me. That was plausible but she must have had a little mouth scrubber with her to make that tongue so clean.

Chest pain and swollen, painful legs associated with long-haul flights can be significant, regardless of age and state of health, so my 25 year-old patient was taken to hospital with her boyfriend after she’d developed it soon after a trip over here from New Zealand. Sluggish circulation encourages clotting which can lead to an embolism and then cardiac, pulmonary or neurological problems. Nobody said she had any of this going on but all the signs were there and it was well worth checking out before she collapsed in a heap on the floor of her hotel.

Speaking of collapsed, my last patient of the night staggered around in the street, clutching his abdomen after calling an ambulance because he had crumpled to the ground and been unconscious for a short time, although how he remembered that is questionable. He described his pain as eleven out of ten, which we all know is as possible as giving something ‘110%’ but I understood this to mean very painful, so I offered him entonox, which wasn’t enough and then morphine, which he seemed glad to have. Too glad, in fact.

I have to administer pain relief if appropriate and so I gave him a little bit to take the edge off his agony but I looked at his arms and the track marks I saw were ringing alarm bells. He insisted that the puncture sites and trails were the result of many, many recent visits to hospitals for his unknown abdominal problem but I wasn’t convinced and he got no more class A drugs from me. He was either an addict or had been unfortunate enough to encounter every medical student in London.

At hospital even the nurses were suspicious and asked me what I thought. I told them I thought the guy was probably a junkie and this was as cheap a way as possible to get a fix (free on the NHS from gullible paramedics and doctors). I also mentioned that there really was no option for me because not giving pain relief when it is required is indefensible in my profession.

I left them to deal with him and mentally photographed his face so that he wouldn’t catch me out again, hopefully. It wasn’t the first time and it won’t be the last; I’m a soft touch apparently. Others less kind would say mug.

Be safe.

Tuesday, 17 June 2008


A reader has created a group for the book on FACEBOOK. It's a bit of fun and I'm happy for her to do this, so if you want to join, here's the link!

Otherwise just go onto Facebook and search 'a paramedic's diary'.

Well, it's publicity for the written word, isn't it? I hadn't thought of this because I'm a bit shy when it comes to blatant self-publicity but the real world is all about that, right? Next stop Big Brother!


Thursday, 12 June 2008

Too Scottish

Fourteen emergency calls; two assisted-only and twelve went by ambulance.

I was very tired when I started this long, busy shift and I was sent immediately I booked on-duty to a 58 year-old with renal failure whose family suspected he’d suffered a TIA after a day trip to the seaside. They ran around the estate guiding me in, which was just as well because the place is a nightmare to navigate around.

He sat in his wheelchair outside in the sunshine and explained that he didn’t feel well. There was no evidence of a new brain insult but he was taken to hospital for checks anyway when the crew arrived a few minutes into my primary.

I encountered my regular Lithuanian gel-stealing friend when a call came in for a 28 year-old male who’d had a '? fit' after being assaulted by bar staff. This turned out to be false; he hadn’t been assaulted by anyone and he wasn’t fitting, although he tried his best, as usual, to put on a good show. The MRU was already on scene and I advise him and the crew, when they arrived, of what I knew of this man and his brother. Both are alcoholics who feign illness to get into various hospitals throughout the day, only to leave laden with spirit gel before they have been assessed. It’s a disgusting betrayal of the trust we show to visitors and those seeking to live in this country – it’s also has a shameful tarnishing effect on the majority of those who come here for honest purposes.

A young man lay face down on a tube platform, perfectly drunk. It took me ten minutes to bring him back to a level of sobriety that would ensure he could get home on his own without tying up an A&E bed. The crew and I walked him to another platform and bid him farewell. He looked appropriately ashamed of himself.

When a bus hits you in the West End, you’ll get a big response from us. Two MRU’s, an ambulance, police and myself were deployed to a minor injury after a 25 year-old female was dealt a glancing blow by a bendy bus. She was collared and boarded just in case and off she went to hospital…just in case. Oxford Street was closed off in both directions as we assessed and treated her, so there weren’t many happy drivers around us.

I wasn’t required for the 44 year-old female with chest pain at a theatre; the crew was on scene when I arrived.

During a routine fuel fill-up at one of our designated petrol stations, I said hello to Graham Norton, who was busily filling his Lexus. I’ve met him before and he’s pleasant enough. I was behind his vehicle (not intentionally) as I travelled back to my area and he mounted the pavement to let me pass when I received my next call and switched on the lights and sirens. Nice to know I could change the balance of power for a few seconds.

GHB is a common recreational drug, especially among members of the homosexual society and it produces complications that can lead to death. Most of the time, however, we are trying to manage an unconscious or semi-conscious and combative person. My next patient, a 25 year-old man whose partner had called us, was no exception. He’d been given the drug by a stranger in the toilets of a Soho club and had collapsed in the street afterwards. Now he was a thrashing, kicking individual with no sense of where he was or what he was doing. The streets were very busy, so as soon as the crew arrived, we got him onto a trolley bed and into the ambulance, where I left him.

We were short of a few ambulances tonight and I was asked to make a very long journey north, well out of my area, for a 44 year-old female with chest pain. I couldn’t find the address after my slog and the crew were on scene a few seconds after I’d managed to locate it and been greeted by the patient, who’d walked herself down stairs to open the door for me. I handed over straight away and made my way back because there was a hole in the cover in my own area now.

I suspect I was sent to the next call because of my origins; a 51 year-old man was complaining of back and abdominal pains but was ‘very difficult to understand due to a very strong Scottish accent’. I guessed I was going there as a medic-interpreter!

I stood outside his secure entry door with the crew but he wouldn’t buzz us in and refused to come and meet us, according to Control when I called in. Ten minutes later he appeared from a completely different direction and we realised we’d been standing at the wrong door all along. I blame the council planning people personally.

He wasn’t friendly and yes, he was Scottish, Glaswegian like myself but he was quite easy to understand, so I let the crew get on with it and did my paperwork. I’ve met this man before and he can become very aggressive. The crew knew of him too and they spent a long time inside his flat. Concern evaporated when I realised they were probably trying to talk him out of going to hospital because he didn’t need to.

A 22 year-old woman walked across a busy road against the traffic lights and got hit by a car for her trouble. She’d been drinking and admitted this to me when I found her sitting in a police car. She had no significant injury and I discovered that the car’s mirror had struck her at low speed. She was still collared and boarded because she couldn’t remember much of the event and this might have been a result of her alcohol intake or unconsciousness after the collision. Neither the crew nor I were taking any chances.

My next patient didn’t like the fact that I woke him from his drunken sleep and he swore at me as he headed off down the street. The 26 year-old man had been found ‘unconscious’ in the street by a worried MOP. I shook the man awake and he found me instantly objectionable; it’s a hard life.

I left the crew to deal with a 25 year-old female who was fitting at a bus stop because I was excess to requirements and was sure I’d be needed elsewhere. I soon discovered I was when I was sent to a 35 year-old man who was ‘unconscious’ on the top deck of a bus.

The dreadlocked six footer was face down and in a very tight space but was easily roused and I sent him packing with the reassuring words that ‘everyone falls asleep on warm buses when they’ve had a drink’. He seemed to understand.

A confusing call for a 25 year-old male ‘unconscious’ in an alley turned into a redirected call for a male with a head injury after a fruitless search for my patient. The call had been made twice but with different details given, generating a duplicate. The crew was already on scene and dealing with a guy who’d been assaulted.

My last call almost ended with a young woman exercising her right to refuse treatment, even though she complained of chest pain. I found her in a doorway with friends; she seemed intelligent and probably articulate but I didn’t find any of that out until later because she wouldn’t make eye contact with me (which always makes me suspicious) and she wouldn’t talk to me. She did, however, hug up to her friend a lot and speak to him every now and then. There’s nothing more frustrating than being called out and having to pry information from an obstructive patient.

The crew arrived and, just as we were going to leave her after she refused for the nth time, she conceded and went to hospital. She was obviously stressed and something happened that I’ve seen a lot – once her friends were out of the immediate area, she opened up. She even smiled a few times for me.

At hospital we waited to book her in and I spoke to her about what could be troubling her and leading to these chest pains, which she’d had before. I discovered she’d been having a lot of problems at work and stress had been dominating her life recently.

‘Are you staying?’ she asked me.

‘Do you want me to?’ I replied.


And so I chatted with her until I’d been at hospital almost long enough to generate a ‘phone call from Control asking where I was. It’s been a while since I’ve spent more than a short time with any of my patients and it softened me.

Be safe.

Wednesday, 11 June 2008

The nearly-dead addict and the very dead crow

Thirteen calls; one hoax, one assisted-only and the rest by ambulance.

The gel-stealing alcoholics are working hard in my area. The first call of the shift was for a 35 year-old man who’d had the audacity to collapse in a doorway in trendy Piccadilly. Obviously, there was no way he was going to go unnoticed and we received a 999 call from passers-by to remove him as soon as possible. We are London's human rubbish street-clearing service.

He was a street alcoholic, laden with stolen hand-gel. I found two pump-bottles of spirit hand wash in his pockets (they were sticking out and I could see them from the car as I pulled up). He also had a Lucozade bottle containing a prepared mixture of water and gel for drinking.

I woke him from his slumped slumber as the crew pulled up on scene. I had already removed his contraband but he wasn’t happy.

‘Mine!’ he shouted in a heavy Lithuanian accent, as he tried to grab back the bottles.

‘Not yours. NHS property’, I informed him.

My next call to a 35 year-old male having an ‘asthma attack’ wasn’t; he had collapsed in a karaoke club after smoking weed (by his own admission) and while his female friends fawned over him, telling me how ‘amazing’ he was, I managed to glean most of what I needed to confirm that he was over-doing it a bit on the drama front. He settled down when I asked the ladies to leave the room.

Meanwhile, a cacophony of ‘singing’ rang out all around me as people attempted to murder some of the best songs in existence.

It’s unusual for me to be called to street-sleeping females but I found my next patient, a 22 year-old, lying on the pavement with her head on her bag as if it was a pillow. She was a visitor from the Czech Republic and she was adamant that slumbering in public after a few drinks was normal for her – she did this all the time at home apparently. Who was I to argue?

She was taken to hospital anyway – she didn’t have clear answers for anything, including where she came from and where she was going. Still, she was pleasant and smiled occasionally, which is a rare treat for me on a weekend night.

A long 3 mile trip into the East End next. The 23 year-old female had fainted in a Chinese restaurant and her family were concerned about her. By the time I arrived, she had fully recovered and didn’t want, or need, to go to hospital. I cancelled the ambulance and filled in the ‘get out of jail’ form.

A homeless shelter back in my own area and a 34 year-old man was feeling dizzy and had pain in his hands. He had a history of high blood pressure and psychosis and his anxious look and nervy attitude made me wonder which of the two conditions was most prominent.

As I sat in the car doing the paperwork for that call a young man approached the window and leaned in.

‘Excuse me, my woman’s stopped breathing’, he said.

Then he showed me a stuffed crow that he’d been carrying around (it was either stuffed or he’d picked it up from the street). He giggled and walked off as if the joke had actually worked. It would have been funnier if he’d said the right line, ‘excuse me, my bird’s stopped breathing.’ Silly fool.

Underage drinking is becoming much more of an issue today because it’s happening in the public domain. I was called to a 17 year-old who was drunk in the street. She slumped against a wall as her friends shouted and swore around her. They all looked about sixteen to me, no older than that.

Another girl, from the same pack, was sitting on the pavement semi-conscious but I concentrated on the one I’d been called to deal with. I spent the next ten minutes doing obs, keeping her awake and receiving abuse from these mouthy teens. I was no more than a servant and my opinion on their behaviour held no water with them. They must have star parents.

When the crew arrived, she was taken into the ambulance and IV fluids were started. Her less than awake friend was also taken aboard but managed to rise above unconsciousness and stay alert when she saw what was happening to her errant mate. If you get so drunk you can't stay conscious, then you are very likely to get a BIG needle in your arm and a bag of salt water connected to it. Tough love.

Outside the vehicle, her other friends were making demands. They demanded that she be taken to a specific hospital, demanded that they be allowed to go with her and basically demanded whatever they thought they’d get away with – nil respect was shown. None of their demands were met.

Speaking of respect, during the treatment of this young girl, a taxi driver had a go at me for parking ‘inconveniently’, causing a queue in the road. He ordered me to move my car, even though it was clear we were busy with a patient and our lights were flashing (this signifies that we are working on an emergency call and we use it to advise other road users of the hazard and possible obstruction we may cause temporarily).

I moved eventually but not at his request. I wondered if he’d be so quick to verbally attack a police officer in the same situation; probably not.

A 35 year-old Polish woman was found lying semi-conscious in a doorway in Regent Street. She had been drinking but not a lot and she was dressed immaculately, so it was unlikely she’d staggered into that place. All she could remember was going to the cashpoint across the road, after that she woke up where she was. It was all very strange and the police used the CCTV cameras to see if they could detect a crime (perhaps a mugging). Unfortunately, the camera nearest the scene was just too far away to catch much and the street was very busy, so a brazen attack would definitely have been witnessed. We had to conclude that she had just passed out or that she had a medical problem.

Another phantom shooting, this time at a club in Tottenham Court Road. I was cancelled by police when neither the victim (shot in chest) nor the shooter were located.

Staff at a Soho club decided to move an unconscious 22 year-old out into the street after she’d been found in the toilets. She was drunk and vomiting when I arrived and I wasn’t pleased to learn of her recent relocation in such a state. I think they thought it would be helpful if she was in a more open space, I don’t know for sure but I had a chat with them about liability in future.

Every now and then I am called to HQ to treat a member of LAS staff. Ironically, in the Control Centre, or elsewhere in the building, if someone becomes ill an ambulance must still be called. I attended a 24 year-old who had stress-related issues, resulting in chest pain and anxiety. It’s easy for us to forget, out on the road, that our colleagues in EOC can go through a shift filled with abuse, distress and blind panic, without the power to do much about it. I have listened in to 999 calls and some of the callers can make life hard for the innocent call-takers on the other end of the line, so I sympathise.

The police were driving behind me as I pulled into the alleyway that I’d been sent to next. A man had been spotted lying motionless at the end of the dark, quiet street. I went over to him and the cops followed me. It took a shake of his shoulders and a few seconds of looking at him before I realised he was in trouble. His breathing was depressed, he was totally unrousable and he had pinpoint pupils; he had overdosed, probably on heroin.

I grabbed my stuff as the two young officers stood over him and asked what they could do to help. I got him on oxygen and prepared what I’d need to give him narcan. His breathing was so shallow that it had to be supported. He tolerated an airway and was ‘bagged’ as soon as the crew arrived to help me.

Narcan was given IV and his condition suddenly changed after a few minutes. As we lifted him onto the trolley, he sat up, wide awake and quite agitated – the miracle of Naloxone!

I left the crew to it and got on with my shift but I learned later on that he stormed out of hospital without further treatment. This is typical; you save their lives but they hate you for it because they paid for a hit and had it stolen from them. I once met a cop who said ‘why do you bother?’ as I struggled to bring back a drug addict a few years ago in a park full of children. He looked around, looked down at my patient and shrugged his shoulders. We both knew he had a point but we also knew it was pointless.

A daft call for a 49 year-old woman who’d taken an ‘unexpectedly cold shower’ and was now complaining of an ‘aching side’. I’d gone up to her hotel room with a member of the hotel staff but couldn’t get an answer when I knocked repeatedly on the door. I must have disturbed a few of the other guests – it was very early in the morning. Then I was told she was waiting, bags packed, with her friend in the lobby downstairs. She’d seen me go past but hadn’t made any attempt to signal where she was.

When I got to her I found a perfectly lucid, virtually pain-free person sitting on a chair. Some people get anxious to the point of making things an emergency for themselves when the tiniest thing happens to them. I considered how secure this lady’s life must be that a simple cold shock to her muscles would develop into a request for ambulance assistance. Needless to say I left this one with the crew when they arrived.

I had five minutes of my shift to go when I received my last job. I went to see a 35 year-old woman who’d just had a gynae operation and had suffered all night with chest pain, probably as a result of the effects of her anaesthetic. I felt sorry for her because she was genuinely in pain and genuinely afraid. The crew were kind enough to arrive fairly quickly from a distance and they were happy to let me go home once I’d handed over…and so I got home late and very tired and with another shift to follow.

Be safe.

Real work

Six calls – two assisted-only and four by ambulance.

The first call of the shift was for a female ‘unconscious’ on a bus. She was asleep, of course and all I had to do was wake her up and move her on.

A strange fitting call next for a 65 year-old Chinese lady who was in the middle of a gambling session on the fruit machines at a casino when she was seen to suddenly collapse and begin twitching in her seat. She was still sitting there when I arrived with the MRU following close behind.

Her upper body was convulsing and she had a left-side head tilt, making it difficult to get eye contact with her. She responded to questions initially and every so often but then became completely unresponsive. When the crew arrived she was moved, still twitching, to the ambulance where I gave her a little diazepam, bringing her erratic muscular convulsions to a slow, although they never quite disappeared, even in hospital.

It’s possible the lady had suffered a neurological insult and had fitted as a result or she had a localised epileptic episode, although nobody knew her and she had denied having any medical problems when she was lucid enough to answer my questions.

More diazepam was given at hospital but she continued to twitch, now more on her left side than the right.

I made accidental friends on my next call to a 48 year-old male ‘not responding’ at a homeless shelter. It was breakfast time and there was a queue outside the door, as always. The patient was known to me – he’s an alcoholic who visits hospital almost every day for no reason other than the fact that he drinks too much and collapses as a result. He wasn’t responding because he didn’t speak English and his brain was probably in a near-liquefied state after decades of abuse.

On my way out, after the crew had come along and scraped him from the pavement, a pack of noisy, swearing Glaswegian drunks decided to quiz me on where I came from and whose part of Glasgow was the toughest. The toothless, cackling woman among them was more vociferous and wanted to me join them for a drink and a remembrance session for the homeland. I declined and smiled politely, as you do. She looked like she was 100 years old but she was probably only 35 – that, I must add, was the extent of my interest in her.

An emergency call for a 49 year-old man ‘lying rigid in bed’ had me racing further south than I usually like, with a delay on my arrival time due to distance. I arrived at an old school that had been converted, quite tastefully, into private mezzanine flats and I was guided by the patient’s partner to his bedside. He lay on his back, thrashing around, soaked through with sweat and posturing in a decorticate manner. I was informed that he had suffered a stroke in the past and this certainly looked like a neurological problem but he was also an insulin-dependent diabetic and my obs revealed a very low BM; 1.7 – and that had to be sorted out before I could be sure of what I had here.

The crew arrived as I completed the primary and we quickly got to work with Glucagon and IV Glucose. He was calm enough during the treatment but became highly agitated and thrashed around again every few minutes, making life difficult for everyone in the confined space around his bed.

He remained unaware of his surroundings for another ten minutes and then his condition began to improve; his BM rose to 6.0 and he became easier to manage, although he complained of severe cramps in his legs. A quick trip to the toilet (supervised by his partner) and then onto the ambulance, with chocolate if he needed it and he was back to normal. He was still taken to hospital because his medical history was significant, his earlier posturing was suspicious and he’d never been in such a critical state with his blood sugar level before.

A 25 year-old female who was knocked down by a bus on Oxford Street had no more than a bruise on her leg but the incident produced two ambulances, a MRU and myself – so you’re pretty safe if you get hit by a big vehicle in Central London. She refused to go to hospital, which was fair enough and two other people, who’d been passengers on the bus when it stopped suddenly, began to complain of leg and back pain as a result of falling over on the top deck as they stood to alight.

Neither of the new patients went to hospital – a quick check by myself and the crew revealed no real injury, although one of the complainants – a young girl – had a good long cry about it until she was over the fright.

My last call of the shift was for a 65 year-old man who’d collapsed onto the floor of a restaurant during a family birthday meal. He had been drinking but his behaviour didn’t scream drunk to me – he seemed genuinely unwell and could possible have suffered a neurological insult. He lay on the floor unconscious for a time, then he became rousable on oxygen, although he tended to slip back into unconsciousness from time to time during my primary. He was agitated when conscious and completely unaware of his surroundings. His frantic family tried to get him to make sense but you can’t force someone who’s not there to be there.

The crew arrived and we packed him into the ambulance where he began to vomit violently and uncontrollably. His airway was in danger because he was unconscious again, so over he went onto his side. When he regained consciousness he fought with us and was difficult to keep still.

His ECG revealed a bradycardia with no P waves (idioventricular rhythm). I had noticed his slow pulse in my primary but the lack of P waves was a significant development. Now that he was vomiting, his condition was more critical than before and alcohol, although probably part of the problem, could be ruled out as the major factor. His BP was dropping and this also had to be addressed, although I had no intention of staying and ‘playing’ with him – we’d already been on scene a while and his condition was deteriorating rapidly – time to go I thought.

I stayed with the crew as we ‘blued’ him in. I cautiously suctioned his airway (overdoing it could drop his heart rate even further) all the way to hospital because he was completely unconscious now and still producing big lumps of vomitus, most of which I pulled out by hand to avoid excessive use of the catheter). He was in real danger of choking on the stuff if I didn’t keep a close eye on him. His family had been asked to meet us at Resus; they weren’t getting aboard because the man was in a much worse state than when they’d last seen him.

Although atropine may have been useful, I had no time to administer it – his airway became the priority and managing it became a full-time activity. He was given the drug in hospital but it had no effect on him (there are certain types of bradycardia where atropine is ineffective). They too had to make do with managing his airway as he continued to vomit all over the bed and floor of the Resus room.

I’d worked with my bag several times today, so it felt like I’d earned my money. I was put into proper thinking mode on half of these calls, which is unusual but refreshing and it made my day go quickly and that is always good.

Be safe.

Monday, 9 June 2008

Armed and angry

Four calls; one dead at scene, one treated on scene and two by ambulance.

Many of my first-of-the-morning calls are like this; purple plus, suspended or ?dead. This one was no exception. A 40 year-old man was found apparently dead in his bed at a luxury apartment in a very, very posh part of London. The place was so plush that he had his own lift serving all the floors of his home!

He also ran his business from there and his employees and friends, who worked from the offices in the building, had arrived to find that he wasn’t yet up and around, which was unusual for him. So they checked his bedroom and found him on his back, ashen and not breathing.

He had been in detox for drug abuse but it looks like he slipped back into his old ways and over-did it this time. A crew was on scene and when I arrived, there wasn’t much for me to do except check the body and confirm life extinct with my colleagues’ agreement. He had been dead for a while; post mortem staining and rigor mortis were evident. His body core temperature was ‘Lo’ and the ECG showed a constant ‘flat line’. This didn’t convince his friend, however, who leaned over as if he could detect breathing or movement. He looked at me, then the crew and then back at the corpse, entirely sure that he had seen signs of life (this is not uncommon in grieving people).

‘Sorry, you have to trust us; he’s gone I’m afraid’, I said to him. I touched his arm and led him away from the body and out of the room.

The police had been called – this is normal practice in such circumstances - and I left the scene after they had arrived and I had completed the necessary paperwork. The crew stayed behind to deal with one other complication; the man’s wife was downstairs and she didn’t know about her husband’s death yet. She was carrying his twins.

A 60 year-old man walked into an office reception and demanded that they call an ambulance because he had chest pain. I arrived to find him sitting on the settee and complaining of a bad cough, for which he was due to see a doctor at hospital. He had taken the bus this far but was still a mile away from his appointment and had no money left, so he used the chest pain story to get us out so that he could get a free ride to the doors! Just to be on the safe side, he developed abdominal pains in the ambulance (he had forgotten his chest pain and knew he’d been sussed).

I treated a 30 year-old female on scene for hyperventilation. She’d never had it before and an ambulance had been called by her worried colleagues. She knew she didn’t need to go to hospital, so when she had calmed down, I left and cancelled the ambulance.

My last call of the shift was very similar to the one I had the day before. A nine-month-old baby was ‘in shock’ (a very misused term) after a three-car collision. Initially and probably because the caller was so frantic, the details weren’t known and I was being sent to a suspected shooting. I thought the patient was very young to have been shot but I raced almost four miles to the scene and found the police controlling traffic around the crash area.

The three vehicles had shunted into each other at a fairly slow speed and there was very little damage to them. The child I had been called out for was in his mother’s arms and looked absolutely fine. He’d been in a child seat when they had been hit. There were two other kids on scene and they had also been in the car at the time. They too, were fine.

So I waited until the ambulance arrived so that the mother could be checked out (she had a little back pain). The crew sped in because they had been under the illusion that this was a shooting too, despite the fact that I had updated Control. They were soon corrected by the scene and their patient.

An armed response unit screamed through the area on the way to a genuine shooting (I assume) but was immediately blocked by a foolish driver who wouldn’t get out of their way, even though he’s seen and heard them coming. One of the cops leaned out of his window and yelled at the offending driver; ‘Are you blind? Get the f**k out of the way, you idiot!’

‘Ooooh!’ said the assembled crowd of crash-watchers in unison. There were gasps from the more sensitive among them.

I kind of understood the anger the cop felt, even though it did look and sound very out of place. In real life, you know, the one we are all living, there’s no room for niceties when a serious, potentially dangerous job is to be done. I guess getting held up for thirty seconds by a confused driver when the pressure is on leads to angry outbursts every now and then. I’ve done it myself on occasion, to my shame - short of swearing at people of course. Still, who’s going to argue with an armed man, especially one who will probably lose his job for shooting another armed man who deserved to be shot?

Be safe.

Sunday, 8 June 2008

Taxi baby

Five emergency calls; one GP referral and four by ambulance.

A 26 year-old man lay writhing in agony on a bench after dislocating his shoulder playing squash. He had done this before but was initially panicky, despite his experience with the injury. He was hyperventilating and demanding a paper bag when I arrived but he got entonox and a sling instead and this brought him back down to earth; the gas has a very beneficial effect in these situations, so he became much more manageable after a few minutes and was practically cheery by the time he was taken to the ambulance.

A crew was on scene and dealing with my next call, for a 50 year-old epileptic man at a homeless shelter. Whether his fit was brought on by his illness or alcohol remains to be seen.

A call for a 1 year-old ‘shaken up’ in a taxi had me wondering if the baby was injured after a crash or had been given a fright and was just emotional and I arrived to find that the taxi had struck a bus at a busy junction. Luckily, the child (and her mother) seemed unhurt. Her son had sustained a bump to the head after hitting it on part of the structure of his buggy when the cab suddenly braked. An ambulance was requested so that he could be checked out and his mother could be reassured.

The baby had been properly restrained in the push-chair but if he had been in his mother's arms at the time of the collision, the call would have had a completely different urgency about it.

Deep south next, for a 71 year-old man with Parkinson’s disease who’d become very ill and had DIB. His carer of ten years, a man who’d been awarded the MBE for his service to the patient, was concerned and told me that he’d never had to call an ambulance before in all that time. The patient was in bed and, although he could speak, communication was often difficult but enough was gleaned from him to determine that he didn’t feel right at all. His chest wasn’t expanding properly on the upper right and so it’s possible he may have a lung injury, although the cause seemed a mystery.

I was told that he moved around his flat by crawling on the floor, so I figured he may have fallen or hit something during one of those expeditions. He was taken quickly to hospital by ambulance with oxygen to supplement his breathing.

The Physician Response Unit (PRU) is a primary care emergency doctor who uses a fast response car to get to patients in the City and parts of the east of London and I worked with him on the last call of the shift. A 42 year-old woman had collapsed at work with palpitations and dizziness (which go hand in hand). She had no previous history of this but she did suffer from PCOS, although I couldn’t see any relationship and neither could the doc. She was given Metformin for her condition, which seemed strange as it is primarily used for type II diabetes but she told us that it was a new drug treatment for PCOS. I wondered if her symptoms were related to side effects.

She was given a thorough examination, including an ECG and advised to see her own GP when she could. Her condition had stabilised and the doctor didn’t feel it necessary for her to go to hospital. The PRU’s role is essentially to reduce the number of ambulances required by carrying out exams and treatment on the spot. Unfortunately, it only runs out of one hospital and serves only a small part of the community...not my area though, which is a shame because we’d probably save a small fortune if we had one.

Be safe.

Friday, 6 June 2008

Dawn of the hand-scrub alcoholics

Nine calls; one cancelled on scene, one false alarm (time waster) and seven by ambulance.

An early start and a call to a 55 year-old male ‘fitting’ on the South Bank. He and his brother were waiting for us – he was lying on a bench going through the act of fitting and his brother explained, in broken English, that they were alcoholics and his brother had been off the booze for a few days, thus the fit. It all seemed well rehearsed to me and my cynical mind was cautious about the next step.

The MRU showed up and did very little except help with my obs; there wasn’t much else to do as the man jerked about on the bench, proving to us how ill he was. I wasn’t buying it and neither was my colleague. Neither did the ambulance crew when they arrived but, with no proof of deceit, he was taken to hospital and his brother wandered off without concern.

Later that day I was called to a 30 year-old male ‘collapsed’ in the City. He had a hospital band around his wrist and the police were on scene attending to him. I recognised him immediately as the ‘fitting’ man’s brother. He’d been in hospital on this side of town and discharged himself. Then he’d feigned collapse to obtain sympathy and another trip to hospital but this time he wasn’t getting it. The crew recognised him too; he was unlucky because he’d managed to draw attention to himself and the people who’d been called – myself and the same ambulance crew as earlier – knew what he was doing. Let me explain...

The man had a bottle of liquid on him and the police made a point of trying to identify what it was. At first it was thought he was carrying alcohol but he wasn’t – he had hospital cleaning fluid on him and he was drinking it. He and his brother had a little scam going; they’d both go to separate hospitals, as many times as possible in a day and steal as much cleaning fluid and hand gel as possible so that they could drink it and glean any alcohol from it. It’s happening more and more and the depth of this fairly new abuse has only just been brought to our attention.

He recovered very quickly when he realised we were on to him and he declined further aid (of course). I referred him to London Street Rescue in the hope that he could be taken off the street but he had a bad record with them and, although they told me they’d visit him to help, I didn’t expect he’d hang around for them. Both men are Lithuanian, neither work or contribute to the country and both are stealing resources openly and without punishment. Can I really be labelled racist for venturing the opinion that we should no longer tolerate such abuse from people we invite into this country for protection and a better life? There are plenty of foreign nationals here who contribute to our society and are part of it – Poles, for example – a few of them are drinkers and we visit them too but at least they are paying for the service!

I was cancelled on an earlier call for a 28 year-old male who fell from his bike when he started convulsing mid-cycle. The crew was on scene and I wasn’t required.

Then a 25 year-old man who was having ‘chest pain’ at a train station. He seemed a bit young for all that and I discovered that he’d actually had a fit and was slowly recovering by the time I got on scene. He was a nice chap (a film producer) and he hadn’t experienced a seizure for some time but was known to have them. He agreed to go to hospital so that they could work out a medical solution for him.

Another fitting person, this time a 30 year-old female, was on the floor of her office and had been convulsing for seven minutes, according to her colleagues. The crew was with me and an MRU arrived too and I got on with giving her diazepam as the oxygen was administered and obs were confirmed. Only after this had been done did her colleagues find out what her condition was; they had a letter stating that she was to be left alone and given nothing because she would recover on her own. On no account, the note said, was an ambulance to be called. Too late for that – they should have looked more closely at it when she gave it to them.

A 60 year-old man who had been arrested for stealing from his employer demanded an ambulance for chest pain and so I was asked to check him out. He told me he had angina and was suffering but he didn’t have his GTN with him and spent most of the time swearing and insulting the police for arresting him when there were ‘real crimes’ taking place out there. He wasn’t at all convincing but he claimed to have a history of MI (although he was vague about the date), so he was treated as genuine and carted off, with a police escort, to hospital.

My second chest pain call was to a shop where a 39 year-old member of staff felt dizzy, had abdo pain (and chest pain) and felt generally unwell. He told me he had a history of this but that nothing had been discovered by his doctors. He went to hospital and hopefully they’ll pinpoint the problem, otherwise he’s destined to go through life suffering.

Multiple Sclerosis is a devastatingly debilitating disease and my next patient, a 25 year-old man, was at home with his family, living with it but now there were other problems and he was vomiting and suffering kidney pains. His concerned mum called an ambulance because, despite putting up with the condition on a day-to-day basis, this was a new development and she feared something more acutely serious had struck.

I was late getting home because my last call took me back into the West End in rush hour. I was going to the aid of a 17 year-old girl who was hyperventilating at a large department store, where ironically, a number of past hyperventilating patients had demanded my attention – maybe it’s a stressful place to work.

It took ten minutes to calm her down and convince her that she wasn’t going to die. Her colleagues were pleased that she was getting better because they had been unable to slow her breathing down and I could hear her from a distance when I first arrived. She insisted on going to hospital ‘just in case it came back’ and I thought she might need to steel herself for life if this was how she generally went about dealing with her concerns. Yes, she’s only seventeen but life is cruel to young, vulnerable and sensitive people. How’s she going to deal with real crises in the future?

Be safe.

Monday, 2 June 2008

On and on...

Another teenager was stabbed to death today, this time not far from LAS HQ and this time a female was killed. Something is unravelling in this country for sure.

I'm going back to Kiev for a couple of days' R&R - normal postings will resume when I return.