Friday, 29 August 2008

Insult to injury

Day shift: Six calls; one false alarm; one taken by car; one arrested on scene and three by ambulance.

Stats: 1 Allergic reaction; 1 Fall ? fracture; 1 Headache.

Assault calls are always tricky because you rely on the information given and the assurance that police are on scene before you arrive, so that you don’t go straight into a conflict. Many colleagues have been hurt, some seriously by misadventure when it comes to calls like these. No amount of counselling is going to make up for the fact that you got damaged doing your duty. So, when a call came in for an assault with multiple victims and ‘screams heard’, I was hoping to arrive with backup on my tail, if not in front of me.

The police were on scene and there were excited looking youngsters hanging out of the window of the building, which is a youth rehabilitation centre. I was very cautious when I entered because I’d yet to be told what was going on and the staff told me that someone was still loose in the building – that someone, I assumed, was the assailant. This turned out to be fantasy; the police had the assailant in custody and the victim (just the one) was in a separate office.

An argument had blown up between the huge man and his petite manager. She was tasked with issuing him with a final warning and he reacted very badly – shouting, slamming his fist on the table and allegedly threatening her, thus the screams (his or hers, nobody knows). No-one was actually physically harmed and it all seemed under control now. I’d asked Control to keep the crew away from where I was until I knew what was happening and I found them sitting in the reception area as if they had an appointment.

Allergic reactions can cause angiodema, which in turn can be life threatening if the airway occludes. My next patient was a 61 year-old man whose tongue had swollen suddenly as he sat on his train into London. He presented himself at a local walk-in centre when he arrived at his station and I was called to assess him. He was given adrenaline and piriton but it hadn’t changed anything and when I arrived his tongue still looked very, very fat, although he could still breathe normally. He tended to talk like a man who’d just come from the dentists after extensive root canal work, so I let him off with minimal questions.

The ambulance was delayed so I made an executive decision and took him to hospital myself on the hurry-up. He was stable but I had no idea how long that would last. I didn’t think I could afford the luxury of a potential ten or twenty minute wait.

When I got him to A&E we discovered that, although he had no allergies and hadn’t eaten anything to cause this, he’d recently changed his prescription antibiotics. That would be the answer then I guess.

A motorcyclist was thrown from his bike when a car collided with him at around 25mph. The car shunted into the back of him because the driver was distracted and looking elsewhere at the time. The knock caused the biker to veer off towards the pavement as he tried to control his machine but it clipped the kerb and he was ejected into a post before landing ten feet from it. I arrived to find a MRU colleague on scene and attending to him. Someone had taken his crash helmet off, despite the protestations of other MOPs and then proceeded to move him into the recovery position, even though he was conscious and alert. This is not to be done as it simply increases the risk to the patient. Leave it to us unless there is a clear risk to life if it isn’t done.

The 45 year-old was in pain; his ribs had smashed off the post and he had a foot injury which we discovered when he was taken into the ambulance and stripped down for checks. A deep cut on his sole indicated that he’d landed on it so heavily that his skin had burst and the energy had probably broken the bones too. His foot was white and bruising could be seen on the top of it. His boots were perfectly intact, so our suspicion of severe impact trauma was on track. This energy can radiate through the bones and damage structures further away, such as the femur, pelvis or even base of skull, so great care was taken with him and he was blued in to hospital.

An 86 year-old lady fell badly at her community centre lunch and sustained a head injury and sprained ankle. The poor woman was lying on the floor in great pain as her peer group looked on in sympathy. I moved the old ladies out of the hall, denying most of them their meals for a while but I’m sure they didn’t mind – patient privacy and dignity are always of greater concern to me than the comfort of others on scene.

She was given entonox and her leg was placed in a splint when the crew arrived. She was wheeled out onto the ambulance and taken to hospital, probably after the paramedic gave her stronger analgesia.

You know I’m not one for foolishness and I think dragging myself and my equipment through a crowded shop in Oxford Street for a perfectly healthy 23 year-old man with a headache is just plain stupid. He had no medical history, no acute trauma and he could easily have taken himself off to his GP…or had a couple of paracetamol. Instead he insisted that I half carry him to the exit while the crew accompanied us to the waiting ambulance. He amplified his drama by pushing down on my shoulder and practically limping as I supported him across the acreage of shop floor. Silly man.

The newest frequent flyer (well, new to me), called us again for a head injury, post assault, that he simply didn’t have. I knew it was him before I arrived on scene – the age, the location and the nature of the call hinted at it and when I arrived I found him inside a phone-box, on the phone to our 999 call-taker. I knocked on the window of the box and asked him to come out. When he recognised me he dropped the phone and I picked it up to explain what was happening and to cancel the ambulance. Risky as this may seem to some of you, I could see immediately that he had no injuries and his face confirmed that fact. He wants off the street but try as we do, he resists all efforts to help him, so I gave him his options, none of which included going to hospital (on the last call to him he changed his mind because the hospital didn’t suit him).

The police arrived on the ‘assault’ call and they too recognised him; he’d been arrested the day before and they pondered over a solution, including re-arrest for hoax calls to the emergency services. At first he sat quietly in the back of my car but then he became abusive with me and opened the door to leave. The officers stood in front of him as he got out and he swore at the WPC and punched her in the stomach – that was enough and he was immediately arrested for assaulting a police officer – ironic really.

Okay, he may have psychiatric problems and he is homeless but I have tried to help him and many of my colleagues are just plain fed up being abused by him when they try to help too, so the only place for him until he is catered for appropriately is a police station cell. We are stretched to the limit because of individuals like this and they are costing you money and threatening to drain resources that could be allocated to your mother when she has chest pain. That’s how I see it and, although I have a duty of care, I also have to exercise it in the wider sense. I’m also a responsible, tax-paying grown-up. I may as well give him a fiver every time he calls us; it would be cheaper in the long run.

As I drove around Piccadilly Circus I overheard a comment made towards me by a man crossing the road. ‘God bless the NHS, it hasn’t got long’, he quipped. What he said rings true and it’s no wonder when we continually pander to the minority of people who over-stretch the service simply because they can.

Be safe.

Monday, 25 August 2008

When pavements attack

Day shift: Two calls; both by ambulance.

Stats: 1 burn injury caused by an explosion; 1 Mental health transfer.

Well, there were more than two calls on this shift but I was on an ambulance and I wasn’t attending today, so I cherry-picked the calls worth writing about.

The explosion on Oxford Street wasn’t a dramatic terrorist attack but it could have been and when the call first came in we were certainly gearing up for the worst because this is how 7/7 unfolded. At first the location was vague and an underground station was named; a MOP had heard a loud explosion coming from the underground, according to the early report but we were diverted into Oxford Street itself and nowhere near the station. A few police cars had parked up and a small crowd had gathered around an area where an alley was congested with Fire-fighters and one engine. A woman stood with her family on the corner and we were told she was the only injured party, so we went over to find out what was going on.

A piece of the pavement (see pic) had suddenly blown up, fragments of it showering passers-by. The cause of the explosion was a mystery, although gas or electricity seemed to be the culprit. Molten tar hit the woman as she passed with her son and husband – it burned her shoulder and stuck in her hair. She was shaken and, apart from the burns, physically sound. Her family didn’t get hurt and nobody else around caught the debris from the blast. The bang had been heard all the way down the street, so it’s possible someone mistook it for an explosion on the underground but this didn’t stop the LFB from showing up in force to check the station anyway.

The area was cordoned off and we took the family to hospital. It was a small, insignificant event but it made us aware of how quickly things can go from normal to dangerous in this city.

It took over an hour to wait for, collect and transport a perfectly physically well man with psychiatric problems, who’d volunteered to go for assessment, to a Mental Health Unit in south London. No blue lights, plenty of traffic and a waste of emergency resources in my opinion. We are struggling to meet demand at times and yet we still have to do transfer jobs that could be managed by a private taxi firm. It’s small wonder we fight for our targets sometimes.

Be safe.


I spent ten days near the town of Bakewell at the beginning of August being the medic for a kids' summer camp. While on a visit to the town, I saw this sign in a small newsagent's shop.

Night shift: Seven calls; one declined; one assisted-only and five by ambulance.

Stats: 1 Abdo pain; 1 Chest pain; 1 Allergic reaction; 1 DIB; 1 Unconscious ETOH; 1 Assault with minor injuries.

Abdominal pain and fainting are kindred spirits and my first call, to a 67 year-old with those afflictions had an infection. She was passing loose stools and feeling unwell. Her past history of CVA had little to do with her current problem.

Up north, a cyclist is asked for help by a man clutching his chest. The cyclist dismounts and the man collapses in the street. I arrive on scene thinking I might have to start CPR because a mini-crowd has gathered and it all looks too dramatic but the man is conscious. The cyclist tells me all he knows but the patient doesn’t speak to me, even though I know he can because my cyclist friend has confirmed this. The man with the chest pain lies there, looking at me and wincing every now and then. He’s pale and clammy and I still think he’s going to arrest in front of me but there’s something under the skin of it all that tells me he’s not as sick as he makes out.

When the crew arrive and we get him onto the vehicle, he becomes Mr. Chatty from Chattyland, Chattyville. What’s that all about? He’s an Irishman on a visit and he’s an alcoholic. He says he hasn’t been drinking though. How many alcoholics tell us they haven’t touched the stuff? Seems like a paradox to me. He’s friendly now and I set off to find more excitement in my world as the crew prepare him for hospital.

The neighbour of a 45 year-old woman who was suffering an acute allergic reaction to chocolate was shocked to find her standing, wheezing and puffed up, at her door. I arrived within five minutes of the call and she was sitting on a sofa looking much better than the description given. She was recovering and had her Epipen handy, although she hadn’t used it. Self-resolving anaphylaxis is unstable because it can kick in again at any time, so she was taken to hospital with adrenaline on stand-by.

If you thought Ipods were only for the young, you are sadly mistaken. I’ve got one for a start…but my 77 year-old cricket-expert patient with lung cancer and acute DIB also owned one. The lovely man looked sad as he was taken away from his home, where he lives alone among his almanacs and whisky. His classical and jazz favourites are stored on a couple of Gigs of hard drive and he made sure it came with him. He is a true gentleman of his generation and he’s now getting too ill to cope with his stiff upper lip.

The cops waited for me over the apparently lifeless body of a Polish alcoholic and I pulled up to see his equally alcoholic friend gesticulating his concern as his mate passed the time on the pavement.

No matter what I did, the man wouldn’t wake up, although he did respond. Every now and then, with deep pain, he’d lift his head…that was it. I could tell that he was an expert at playing possum and incredibly, he’d become completely accustomed to our pinches, rubs, shouts and needles. It’s a lifestyle, I suppose.

The crew fared no better and once I’d hooked him up for fluids, he was carted off to the sanctuary for alcoholism that is St. Thomas’ hospital. It’s shameful that such a famous institution has been downgraded by society’s lowest rung.

On the way off the ambulance, as his trolley bed was moved across the ramp, he took the time to wake up momentarily, life his head and spit onto the floor. He knew where he was, he knew who we were and he knew what he was doing. It’s not even clever.

A 31 year-old female was allegedly assaulted in a club in Soho and I was asked to attend because she had grazes and broken nails! The ambulance crew arrived, rushed out and one of them said ‘we heard there were broken nails involved, so we got here as fast as we could’. Hey, it’s a chuckle in amongst the pain, isn’t it? Anyway, the woman didn’t want an ambulance; the police had called us as a matter of routine.

I met the new frequent flyer with psychiatric problems again tonight. He calls us with spurious reasons for needing an ambulance, this time it was ‘fainting’. He came out of the callbox when I pulled up and sat, in his usual place, in the back of the car. I called the Street Rescue people about getting him off the street because now I recognised his real problem and I genuinely want to help him. I also want to stop him calling ambulances because this was the fourth time he’d dialled 999 today I learned.

The crew weren't happy to see him because they had taken him to hospital earlier and now wished they were doing something useful. I could see their point but we had to do something with him. I offered him the chance to go to another hospital but he wasn’t interested and suddenly changed his mind about it all. I gave him a blanket and sent him to a doorway so that he could sleep safely. I would see him again all too soon.

Be safe.

Sunday, 24 August 2008

New kid on the block

Night shift: Seven calls; one treated on scene, the rest by ambulance.

Stats: 1 ETOH; 1 Psychiatric problems; 2 Chest pain; 1 Abdo pain; 1 Drug overdose with head injury; 1 Asthma.

Early into the shift I am requested for an 18 year-old girl who has collapsed at a busy bar near Leicester Square. Her friend is convinced that her drink has been spiked because (and I’ve never heard this before) ‘she’s never been like this’.

Despite being told over and over again that she’s only had a couple of drinks (never heard that one either), she looks like a girl with plenty of booze on board. She’s unconscious and has vomited at the feet of customers who are trying to get on with the business of enjoying their night out, even though there are two paramedics (myself and the CRU) among them spoiling their fun.

After a few minutes the girl seems to be recovering a bit; she tells me she’s been drinking all day – then she slumps back to sleep and that’s the last time I hear from her while I’m attending. I put a line in and fluids go up to support her diminishing BP. Fluids are also very good at flushing alcohol through the system, so she should wake up soon.

The crew arrive and take her away. I’ve had to control the emotions of her screeching friend a couple of times with stern words and I regret being a little harsh with her at times but it’s hard to concentrate when you have crowds around you, a drunkenly unconscious patient and a banshee in the same periphery.

As I tidy up the debris from my labours and gather bits and piecesd from a table I’d used, I apologise to the two ladies who have been sitting at it and who, all the while, have patiently got on with their drinks a mere two feet from the disturbance. They smile, thank me back and ask for my phone number. Of course, I’m not shy and don’t mind the attention at all. ‘It’s 999’, I say.

My first encounter with another regular next. He’s been in the area for months but I have never come across him, until now and for the next few shifts. The 29 year-old man is small, quietly-spoken and vulnerable. He’s living rough and has psychiatric problems. He has called an ambulance for ‘chest pain’ and I believe him when he says he’s ill. He is in a callbox which is literally a hundred metres from the hospital. The clues were there but I chose to ignore them because I felt sorry for him and I believed (and still do) that he needs help.

His lip is cut and he offers no reason for this. He sits in my car until the ambulance arrives and I can see no reason not trust him, so he’s taken to hospital. Only after this am I told by another crew that he is a frequent flyer. I thought I knew them all.

A big 40 year-old Irishman with chest pain kept apologising as we helped him. He’d suffered for a week and thought it would go away but it’s now much worse and he has had to give in and call 999. He’s an alcoholic by his own admission but he’s not been drinking, he tells us. GTN helps him a little but the crew are taking him in because we don’t take chances with chest pain and this is genuine.

Many of our ‘chest pain’ calls are nothing of the sort. As I explained before, a lot of people cannot differentiate between chest and abdomen, so my next call didn’t surprise me. I walked into the shop, where late night workers were re-stocking shelves, to find a 26 year-old man laying flat on a table. He had abdominal pain, which he scored 10/10 and he was so uncomfortable that he couldn’t keep still. This is one of the signs of true pain.

I didn’t know how long I would wait for an ambulance and fifteen minutes had gone during my obs and questions, so I offered him pain relief and opted for morphine, rather than entonox because the former is much more effective and long-lasting than the latter. I was drawing it up when the crew got on scene and gave him a small amount to get him to hospital.

Another genuine chest pain and a yappy dog at the address of a 50 year-old woman who’d held out for 4 hours before her husband decided enough was enough and dialled 999. She looked unwell and the crew, who arrived behind me, took her swiftly away…I wasn’t going to slow this down by playing on scene. The dog was relentless and his bark rang in my head a few minutes after I left. They don’t need a smoke alarm at that house.

GHB again and a 20 year-old Spanish man stood in the doorway of a club, supported by the doormen on duty. It’s raining now and I’m getting soaked as translations fly between me, the patient and the intermediate on the door. He’s okay but kind of out of touch after taking the drug, so when the ambulance arrives I leave them to deal with him.

Last call; a 24 year-old bodybuilder suffering an asthma attack at home. He’d been woken up by chest tightness and he was wheezing a little but not at death’s door. I sound him out, give him a neb, wait while he recovers and take my leave with the crew when he confirms that he is much better and would rather stay at home. I remind him on the way out that he needs to put some muscle on because he’s looking weedy. You can have a laugh with blokes who look like the Hulk because they aren’t easily offended and you get one chance to duck if they are.

Be safe.

Saturday, 23 August 2008

Bring on the nights

Night shift: Eight calls; all by ambulance.

Stats: 1 Unwell adult; 1 BP problems; 2 ETOH; 1 Drug overdose; 1 Abdo pain; 1 Asthma

The night starts with a 55 year-old lady with little wrong with her. She’s lying in bed, family gathered around, hyperventilating, not communicating and occasionally thrashing around for effect. We see this a lot and there’s nothing we can do to help because hospital is not the answer. All her obs are normal; she just hasn’t taken her usual meds and is now feeling under the weather. She’s been fasting all day and hunger can throw up anomalous symptoms. I leave her with the crew.

In Theatreland a 40 year-old man is stuck in a standing position near the end of an aisle after watching a show with his wife. He suffers from arthritis and his leg has simply given up the will to work, so he can’t move without pain. His doctor took him off his diuretic and now he’s trying to cope with swollen joints. His hugely inflated wrists hint at the discomfort he’s in. His blood pressure is high and he is a little breathless. It’s an awkward, heavy job to move him into a chair and off to the ambulance but with three of us on scene the task is completed with minimal embarrassment to him. He’s resolute and wants to help himself as much as possible, so it’s hands-off when he requests it…until he needs it.

A silly 25 year-old female socialite collapsed behind a toilet cubicle door at a pub and now she’s stuck fast with her head lodged against the door, so it’s impossible to gain entry to assess her and she won’t wake up when I call to her. An off-duty and slightly drunk doctor is assisting and gave me a hand-over of sorts when I got on scene but she’s overly dramatic and insists the patient has stopped breathing. ‘She was snoring and then she stopped’, she tells me. 'I can intubate', she states. So can I, I thought to myself.

After a fruitless five minutes of trying to get into the cubicle I request the LFB because the door will have to come off, especially if what the doctor presumes is correct, although I doubt it. Upstairs the bar is packed and I know that moving her from here to the outside world is going to be a problem, so I’m hoping the ambulance won’t be too long.

As we wait for her to regain consciousness or for the Fire Brigade to turn up, the police arrive and they begin to plan the best way of getting through the door but all efforts to push it open are stymied by the presence of her head and the risk to her neck if we force it too violently. Useless tools are brought down for us but the door is solid (good quality toilet doors – very unusual).

The crew show up and the smallest of us manages to get an arm through to prod the woman hard enough to get her to wake up. She had started snoring again but it had nothing to do with her airway and much to do with how she sounds when asleep. She moans and wakes up enough for us to make it clear that she is causing havoc. She moves on demand and we get in, bring her to her feet and march her out of there before she has a chance to relapse. She hasn’t taken drugs; she’s just too drunk to stay awake. She isn’t apologetic and she isn’t thankful, she’s a perfectly inebriated Sloane girl with no regard whatsoever for the concern and trouble she has caused.

When she is taken to the ambulance a ‘friend’ of hers approaches the car and asks me if she’s alright. ‘Yes, she’s just drunk’ I tell her. Then I ponder what kind of person allows her friend to go AWOL for so long without bothering to investigate, especially when twenty minutes has elapsed and ambulance, police and fire service personnel start arriving on blue lights and sirens. I’d want to sit down and have a long chat with a friend like that.

Another unconscious GHB victim lies in the street in Soho and only a club manager and her security man are helping him. He’s a 25 year-old and by the time I arrive he’s waking up. The crew arrive soon after me and he’s walked to the ambulance and out of the crowded bliss he slumbered in.

An aggressive, drunken Lithuanian man, known to us in the area, lay flat out on the pavement near the train station. A concerned citizen called the ambulance and I show up and recognise him. The crew arrive and together we persuade him to get up but he’s not happy and wants to demonstrate how much he loathes us all, so he unzips his trousers and urinates in front of us. He pees and pees and pees – the flow goes on until a little river of urine is flash-flooding its way towards my car. His bladder must be the size of a camel's hump.

He finishes after an age then brings his filthy hands up to his face for a quick rub of his mouth and chin. I’m encouraged by the thought that the only person he’s contaminating is himself but he staggers towards the car and I feel the need to green up and leave the crew to it as they await the police.

I thought the next call was a no-trace because I couldn’t find the 23 year-old man with abdo pain at the location given, so I toured around until I was windmilled by him. He’s on anti-depressants but hasn’t been taking them. He’s also had a large amount of alcohol and I’m guessing it’s a substitute. He could have walked to hospital and it would have taken him all of ten minutes but he felt the need to exercise his God-given right to dial 999 and utilise the service that tax payers fund on his behalf. He gets his wish and an ambulance comes to collect him.

Before I leave the scene a passing motorist asks me for a vomit bag for his drunk girlfriend who is about to throw up in the back of his car. She’s holding a pathetic little paper cup under her chin in the vain hope that the deluge to come will be securely caught and stored in it – she has obviously never studied physics…or common sense.

A homeless 67 year-old man walked into a police station in the early hours complaining of chest pain. He’d taken his own GTN but with no relief and as I carry out my obs, I find myself more convinced of his need for a bed rather than medical care but I am no position to judge this on the face of it and wouldn’t dream of re-considering his request to go to hospital. Even if all he needs is a warm place to lay his head, I can see no harm in helping him get that.

My last job for a 51 year-old asthmatic whose inhaler doesn’t seem to be helping him required no more than basic obs from me because the crew was on scene before I’d started any treatment for him. This brought me nearer home and my trip back to the station was uneventful.

Be safe.

Friday, 22 August 2008


Night shift: Ten calls; two refused, two no-trace and the rest by ambulance.

Stats: 1 ?CVA; 2 Head injuries; 1 ? Tetanus; 1 Anaphylaxis; 2 ETOH.

My first call of the evening, to a 72 year-old female ‘? CVA’ was to a familiar address. It was the patient who’d slipped under the bed a few days before. Now she was in real trouble. She wasn’t smiling – she was crying. Her face has changed and she couldn’t communicate vocally at all. I felt terribly sorry for her but I knew that with cancer of the brain, fitting and other neurological problems, including stroke, were bound to occur. It didn’t stop me feeling her pain though.

A girl walks into a Chinese restaurant in Chinatown, orders, eats and then attempts to leave without paying. When she is confronted by the small Chinese manageress, she refuses to pay and says ‘you can’t do anything about it because you can’t touch me’. Then she tries to leave. She is again obstructed by the feisty little owner and the customer attacks her, smashing her in the face and breaking her cheap wooden jewellery on it as a punch is landed on her head. A male colleague attempts to intervene and protect his boss but he too becomes a victim and gets a punch in the eye for his troubles. The girl then storms out but is caught and arrested by police, who are always nearer than you think in this part of town.

I sat with the lady as she nursed her head. She hadn’t been knocked out and her injuries were minor really but she was badly shaken and broke down in tears a few times as I carried out my obs and asked her questions. At first she didn’t want to go to hospital but then she relented (the crew persuaded her it was best).

Bad people who know their rights should be stripped of them when they abuse them to such an extent. I couldn’t imagine stealing food like that and then using my human rights to get away with it. The right not to be detained physically should never be used like a cloak of invisibility but there are always people out there who will defend such a person…until they harm them or their families.

A funny story from the annals of stag history next. I arrived on scene for a 33 year-old male with a head injury and the police officers on scene were grinning at me. ‘You’re going to love this one’ the lead cop said to me as I pulled up.

On the pavement, wearing a field dressing applied by the police medic, was a sheepish-looking man. He was on his stag night and had, for reasons only known to himself, smashed a champagne glass, full-force, into his own head ‘for a laugh’. It turns out the joke was on him because nobody could believe he’d done it and his head was now gashed and blood was pouring from the wound. He was, in his defence, very, very drunk.

‘I’ve been really stupid’, he told me. His mates took photographs of him as he sat with a new bandage on his head after I’d taken a look at the wound. He was a very likeable bloke and he had a sense of humour about the whole thing but I wondered what his wife-to-be was going to think of his new permanent scar and the life-size photo’s that were going to be shown at his wedding during the Best Man’s speech.

It’s been the year for multiple drunken females in single calls for me. Two drunken women were falling all over the place as I drove by after the last call. I pulled up and asked if they needed help and a MOP who’d tried to assist told me that they’d given him abuse. I decided I’d leave them and they pretty much ignored me anyway. The taller of the two dragged her sleepy friend off across the Euston Road and I watched until they were off my radar and out of my realm of responsibility.

A 24 year-old complaining of feeling ‘unwell’ with a ‘tight chest’ seemed very genuine to me when I examined him as he lay on his sofa. He had a temperature of 38.0c and his BP was low. He’d been abroad recently and had also been treated in the not-too-distant past for a cut finger that had become infected. His tetanus status was unclear because he couldn’t remember if he’d had a booster in the past ten years. The one aspect of his presentation that struck me as unusual was that his fingers were stiff and bent; tetany it’s called. This, his high temperature and the chest tightness and discomfort he was feeling made me think of one thing – Tetanus infection.

An anaphylactic 17 year-old male stood on Oxford Street waiting for me as his face and throat swelled after eating something he was obviously averse to. He hadn’t brought his Epipen with him and so he got on-the-spot treatment before being taken to hospital, where his IV care continued. If you are anaphylactic, carry your Epipen at all times.

Another of our famous frequent flyers has re-appeared on the scene after a stint of absence – I think they work in shifts. This one is notorious for calling us three or four times a day and he lugs cases around with him as if he’s on holiday. There’s never anything wrong with him and hospitals in the area simply chuck him out after a while. Sometimes he’ll call an ambulance the minute he’s been ejected, only to be returned to the A&E department that didn’t want him. Sometimes he demands to go to a different hospital. Most crews know him but some do not and every now and then he fools them into doing his bidding. Normally I wouldn’t care but he, like so many of the others, is going to contribute to the death of a genuine patient as he ties up crews all day long.

This time he was on a bus and had to be lifted out of his seat before going to the ambulance. He won’t move unless he is sure you are going to take him to hospital – that’s his M.O. He can also be aggressive and violent when he feels like it or he doesn’t get what he wants. I often wonder why his rights are more important than ours.

I was flagged down to assist a diabetic who was ‘unconscious’ but I could see that he wasn’t. He and his friends were boisterously crowding on the pavement as they tried to drunkenly manage each other. His brother insisted that he was ok but the Polish man who’d drawn my attention to him wasn’t satisfied and shouted at me for doing nothing to help. I told him I couldn’t because he’d refused and his brother was going to take him home but Mr. Angry was most insistent. So much so that he started an argument with the small crowd of drunks. A punch-up looked inevitable, so I stood myself in between them to calm them down. I shouldn’t really do this but I’m from Glasgow and it’s in my nature. The fight was avoided and I continued on my way.

Two no-traces for the end of my night. The first for an unconscious man lying in the street outside a McDonald’s was invisible. He’d probably walked off. My presence prompted the security man at the McD’s to ask for advice about whether he should go to hospital by ambulance or not after being assaulted. I looked at the large-framed man and I looked at the smallest cut in the world and I couldn’t believe he was serious.

The second no-trace was for a 21 year-old unconscious drunken male. He didn’t exist either. I wish all unconscious drunken people were figments of my imagination.

Be safe.

Wednesday, 20 August 2008

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Day shift: Seven emergency calls; one assisted-only, one taken by car, five by ambulance.

Stats: 1 Fall (no injuries); 1 EP fit; 1 ?TIA; 1 Toe injury; 1 Broken nose; 1 Stomach ulcer; 1 ?CVA.

A lovely lady with brain cancer fell out of her bed and slid under it somehow – I found myself crawling underneath to untangle her head and body from the cables that had wrapped themselves around her as she struggled to escape (the bed was motorised). Then I carefully pulled her out of the darkness as her husband and carer looked on. Her body was permanently stiff because the muscles are in a state of constant tone, so she was difficult to manage and her inflexible frame, slight as it was, made sitting her up a bigger task than it should have been.

Apparently this was the second time she’d slipped from the mattress and gone under the bed. I suggested to her that she was hiding deliberately and that brought a smile to her face. She was in no pain, apart from an ongoing hip problem that, given her medical history, couldn’t be fixed, so I waited for the crew to arrive and we lifted her back onto the bed where she wanted to stay. I was to see this lady again soon.

In a posh flat overlooking the river, a teenager had a fit in his bedroom and his worried parents called an ambulance. He hadn’t fitted since he was 7 years-old, so a trip to hospital was definitely on the cards and his mum and dad explained that they were all due to fly out on holiday later on that day. I couldn’t promise them a delay-free flight and I left it to the crew to complete the obs and take them away.

Then a 40 year-old woman who’d had a near-faint and recovered with right-sided weakness and was ‘not alert’ became my next patient later on in the morning. Her work colleagues had called us because she didn’t seem right to them. I had to agree; she was vague and a little confused. The FAST test I carried out was negative but when the crew arrived and did another one, she failed the arm-drift test – patients sometimes do this to me…I say one thing and they prove me wrong. She was taken to hospital on the suspicion that she’d suffered a TIA.

Those plastic shoes that little girls wear – the ones that you can stick colourful studs into – are dangerous on escalators I think. My next call was the second that I’d experienced where a child’s foot had been gripped by the teeth of an escalator step as it reached the top. The toe is usually pulled in towards the edge and becomes trapped (and crushed) inside the shoe. Now obviously I don’t want the manufacturer of these shoes to get all legal with me but, in my opinion and having seen a couple of identical injuries involving this particular type of footwear, I can only assume there is a connection. Blame the shoe or blame the escalator, feel free to choose.

The 6 year-old was crying her eyes out as her mother nursed a badly torn big toe. The damage was severe and it looked like a partial amputation. It had bled a lot before clotting and the suspect shoe was lying on the floor with a chunk of the front missing and those tell-tale teeth marks across it. I’m sure the child’s toe can be repaired but I would ask parents to be vigilant when accompanying their kids on escalators, especially if they are wearing this type of shoe; keep them well away from the inner edge of the step and get them to walk off as soon as possible when the stairs have reached the top. On each occasion the child has been able to free themselves from the step as it crushed their toe but I dread to think of how much pain they would endure if they became trapped in the moving mechanism properly.

Remember the advertising board that flew off in the wind and killed the young woman who was walking past? Another incident occurred in the West End and the similarity struck me immediately when I got on scene. So much so that I had the LFB shut the road down for a while.

A motorcyclist was hit by a board that came away from scaffolding as he pulled away from the traffic lights. The heavy card slammed into his helmet and part of it intruded through his partly-open visor, breaking his nose and throwing him from his bike. Luckily, I found him standing at the scene with witnesses, including the building safety manager. I looked up at the other boards and at least one other was ready to come off in the strong wind, so I suggested we get the Fire Brigade down to secure or remove it. There were people walking underneath all the time because it was a busy pavement, so the risk of injury or death was high enough to warrant such a drastic step I think.

The police closed off the road and the LFB arrived with two vehicles, including a ladder, to remove some of the boards (see pics). The 26 year-old patient was taken by ambulance to hospital to have his injury treated. He was badly shaken by the experience, as you can imagine.

A 30 year-old man complaining of abdominal pain probably had a stomach ulcer, I decided. He had a history of ulcer and the pain was similar, he told me. His obs were normal and he was stable, so I took him to hospital myself in the car, rather than use up an ambulance. This call had come in as a ‘chest pain’ but you’d be surprised at the number of people who can’t tell the difference between their chest and their abdomen. We have another saying in Scotland and it describes such confusion in a more general sense…

In a busy McDonald’s ‘restaurant’ a 14 year-old girl suddenly developed speech problems and a facial droop. This is very young for a CVA but it doesn’t rule it out. The crew was on scene at the same time as me, so I stood and watched as they spoke to the parents about their fears. I’m hoping the staff of this particular McD’s didn’t know what was going on because if they did, I wondered where their first aider was…or their caring Manager. One thing’s for sure, the crowds from the street cared not one bit for this suffering teenager and continued to bustle past her as the crew attempted to make sense of the situation. The least people could have done was make a bit of space for them. Clearly the pain of a human being is second to the joy of an imminent burger. Humanity’s in the bin.

Be safe.


Lovely view, isn't it?

Day shift: Seven calls; One taken by police; one taken in the car; the rest by ambulance.

Stats: 1 Faint; 1 RTC with rib injuries; 2 Abdo pain; 1 EP fit; 2 ETOH.

A 24 year-old man fainted at work. The crew was on scene and I wasn’t required after initial obs and a speedy recovery (the patient, not me).

Then I was on my way to a 24 female who’d been hit by a reversing car in the garage in which she worked. The East European woman was sitting on a chair, crying to herself with nobody helping her when I arrived. She’d been badly shaken by her experience and had rib pain. The driver left the garage after hitting her and was only tracked down when the police arrived and chased him up. So, a caring employer and a guilty employee – nice combination of reassurance for one of our foreign workers.

A man with abdo pain walked down, with assistance, to meet me at his office building. Despite the insistence of the first aiders on site, he’d decided not to stay and wait for me. He was incredibly uncomfortable and had a history of kidney stones – he told me this pain was very similar and I believed him. The ambulance arrived during my initial obs and he was taken inside for some much needed pain relief.

Another abdo pain and another working man. This time, a builder and his brother walked into the local medical centre and an ambulance was called after the nurse judged him to have a potentially serious problem. He was in a lot of pain and morphine didn’t seem to touch it, even after the crew arrived and ten minutes had elapsed. He’d had a sip of beer at lunchtime and his stomach had retaliated, so he may have an ulcer. He certainly had the history for one; stress, stress and more stress from what his brother told me.

I waited 30 minutes for an ambulance when I arrived at the home of an epileptic 29 year-old man who’d fitted and was now recovering. He didn’t really need to go to hospital; they rarely do but his worried brother, who’d found him having a seizure on the floor, was adamant. So, I waited for transport until I decided he was fit enough to go in the car and I took him there myself. He only every fitted once, he told me (just in case the pedants out there believe I took an unwarranted clinical risk) and he didn’t usually need to go at all after an episode. Ironically, his brother declined to join him.

There were two drunken women lying in the street in broad daylight (it wasn’t even 6pm yet), hugging each other and ‘not responding’, it’s not a fairy tale from Olde London Towne, it’s my reality, unfortunately. The two were found by a passer-by, of which there were many in this busy part of town, apparently out of it on the pavement. I arrived to find a security man from a nearby office block trying to prise them apart. They must be very good friends, I thought.

When I approached one of the women said ‘I don’t know her, get her off me please’. She said it in one of those drunken, not-telling-the-truth voices and although I tried, I couldn’t get the other woman to loosen her grip – she must have been a wrestler or something in sobriety. Eventually we got her to let go and the first woman was taken away by a work colleague too embarrassed to talk to me much. ‘I’ll take her home, don’t worry’, he said without eye contact. That suited me fine but it left me with the other woman, who was now going mental at the thought of being separated from her inebriated surrogate twin. I still wonder why women seem to have much louder voices than men when they are drunk. Did God build this in for a laugh? It's not funny, it's annoying. I danced with her for a while on the street, to the amusement of the local builders and office workers. She wouldn't let go of me now and she was very strong (or I am becoming very weak).

Even when the crew arrived the battle for supremacy continued on the street as she clawed at us, moaned about losing her friend and generally misbehaved (she was in her 40’s at least). I had struggled to keep control of her on my own for a bit and she very nearly dragged me into the oncoming traffic a few times in her desperate bid for freedom. Normally, I’d let her go but she was far too drunk to make it across the road safely.

The police were called because this was beyond medical help but they didn’t arrive for another twenty minutes, during which time I was dragged across the road successfully – with one Mercedes driver (there, to shame you I’ve named your car) refusing to stop and almost running into me as I stretched my arm out and showed him my gloved hand in an attempt to manipulate his brakes with mind power. One of these days...

Then she tried to drag me down an alley to ‘show me something’. I told her I’d seen everything I needed to see and she pawed my face and told me I had lovely eyes. I didn’t mind that, even from a drunken person because we don’t get enough praise quite frankly. The last time I’d been told my eyes were lovely it was a 20 year-old drunken male and he’d leaned over from the seat in the ambulance to kiss me (I think), so I won’t count that one if you don’t mind, especially as later on it took four police men with drawn batons to get him out of the vehicle.

When the police turned up the crew had joined me to gently but firmly restrain the woman (for her own safety of course). The officers thought it was all highly amusing and I could see the funny side when she was being bundled into the back of their car after refusing to be nice. Her head simply did not want to follow her body into the vehicle. The cop had to push it in manually. She’ll be very proud of herself in the morning, if she remembers anything. Her friend has probably cut all ties with her now. Ah, the cost of alcohol keeps rising.

A Red1 ‘life status questionable’ for a male who was clutching his chest had me all confused. Surely, I reasoned, if he was clutching, he was breathing? Who am I to judge such things when on high, better knowledge is held? Off I went then, only to find that my patient was a drunken Polish man who claimed a security man at the local Tesco’s had hit him, thus he was clutching his chest. You see, it all makes sense now, doesn’t it? Clearly he was a Red1.

Anyway, I didn’t believe for one minute that a respectable place like Tesco would employ a thug for security, so I assumed that he was either lying (which might seem harsh but he was drunk and very vague, even in translation) or he had done something to provoke the security shoplifting and not allowing himself to be caught. I’m a hard judge of human nature but I’m biased towards sober people these days, sorry.

Be safe.

Monday, 18 August 2008

Injured queens

Day shift: Six calls; one false alarm; five by ambulance.

Stats: 2 Head injury; 1 Angina; 1 Allergic reaction; 1 Emergency transfer; 1 Cut chin.

This was my second shift on an ambulance and it started early on with a ‘one under’ at a busy train station. We were almost on top of it and could see the fire engines, police cars and other ambulance vehicles ahead when we were cancelled. Since we were passing the scene, we stopped and asked a crew what had happened – there was certainly enough fuss.

Apparently a man had jumped but the train had just gone passed him, so he fell into the pit on the track. He had minor injuries and a crew were dealing with him. He hadn’t tripped; he’d allegedly leaped with the intention of going under the train – strangely the entire length of the train had already passed him by before he acted on his impulse. He literally missed his train.

Later on we were standing over an unconscious 24 year-old Colombian man who’d collapsed in front of his friends after a night out drinking. He wasn’t drunk, they suggested and he definitely hadn’t taken any drugs...they suggested. Nobody’s is ever really sure about the drink and drugs habits of their close friends. He had a head injury – the result of falling and meeting the ground, so his condition may have been caused by this, although I had to bear in mind that he fell first, so he was probably losing consciousness before his head hit the ground...bringing me back to the possibility of drink, drugs or both.

His vital signs were abnormal - his pulse rate was slow (35 bpm) and irregular and his blood pressure was consequently low. He didn’t respond at all throughout our time with him and we were on scene long enough for him to have woken up if he’d wanted to. I’d given him narcan and that hadn’t helped, so now he was on fluids and I’d lifted his pulse rate with atropine. His vitals were stable enough after twenty minutes on scene and it should have taken us less than ten minutes to sort him out and get going except for a bus driver who clipped the ambulance as we worked on the patient inside. He’d tried to take a turn around our vehicle and misjudged it badly. Then he spent the next ten minutes shouting at me and my crew mate because I’d stopped him from driving off after the accident!

We got the young man to hospital and he was poked and prodded by even more people in an attempt to find the solution to his state.

A 68 year-old man had an angina attack at a police station, where he was being held on suspicion of alleged fraud. He was the perfect Essex type bloke from the old days...a gentleman. He’d sorted his pain out with his own spray and the police doctor had attended to him but because the police get a bit paranoid when it comes to people potentially dying in their custody, he went to hospital for checks.

It’s been a long time since I gave an injection to a small child but my next call, for a 2 year-old girl who was having an allergic reaction, forced me to make a quick decision about whether to leave it to the hospital staff or to do it myself. At first she’d been fine – swollen lips, rash...the usual stuff but she quickly became more lethargic and floppy and her airway was becoming swollen. I gave her a shot of adrenaline on the way to hospital and by the time she arrived (literally two minutes), she was beginning to look much better. The medical team worked around her for a short time and I watched her bounce out of the hospital with her parents fifteen minutes later. A miracle.

Some of the saddest jobs I do involve children and our next call was an emergency transfer. We had to take a 4 year-old boy from one hospital to another for specialist treatment. It was a long trip on blue lights and took up a lot of our afternoon.

The child had complained of earache, which his G.P. diagnosed as an infection but it got worse over the course of a few days and his face began to swell on one side. He was taken back to his doctor, who repeated the diagnosis of infection. The parents weren’t convinced and when he complained of great pain and his face became even more swollen a few days later, he was taken to hospital, where a scan revealed a massive, intrusive tumour.

He sat on the trolley bed with a smile on his face and a large family gathered around him as we left the hospital. On the way he began to feel pain again and was crying his eyes out by the time we got there. I could do nothing to relieve his discomfort because the doctor had already dealt with his meds before he left. We took him up to his new bed and left him with his doting mother and weeping father. My crewmate and I stood in the corridor and discussed the non-existence of God.

The shift ended with a farcical call in a park. A gang of gay men were playing rounders when two of them collided head-on at speed. One had a head injury and had been knocked out and the other had a deep cut to his chin. The MRU was on scene and had attended the man on the ground (the head injury) as it started to rain. From the very start, this man was a bit obstructive. He didn’t want his head and neck held still – he didn’t like the collar and he refused the continuance of his care twice before we were able to talk any sense into him. The other guy – the one with the cut chin – behaved like an adult.

We took them both to hospital at the same time and on the way, our chin-injury patient said ‘I’ll bet you didn’t think you’d be coming to the aid of forty queens playing rounders’. Funnily enough, it hadn’t crossed my mind.

Be safe.

Sunday, 17 August 2008

Truck work

Day shift: Nine calls; all by ambulance (funnily enough).

Stats: 1 Anal pain (no jokes please); 2 Unconscious, ?O/D; 2 Abdo pain; 1 CVA; 1 Fracture; 1 Fit and 1 Generally unwell.

The powers that be have decided to pull all of the FRU’s off the road. The motorcycles will be replacing us on the basis that they are faster and better looking – leather has always been more popular than cotton. I will be back on my old line and back on an ambulance with a new crew mate for a stint until something changes again (and it will). I’ve been running around Central London in that little yellow car for three years now and I will miss it (I think). I’ve been on a couple of ambulance shifts, one of which I write about here and have two more shifts on the FRU before I hang up my badge and gun, either for the last time or for a hiatus – who knows?

So, a 61 year-old bowel cancer patient with a painful anus requires our attention and we discover she hasn’t been taking her pain killers properly – she’s been taking four a day instead of two, four times a day. No surprise then that she had a bit of discomfort. She walks out to the ambulance with us and we chat all the way to hospital. She’s Italian and quite funny, considering her predicament.

The first of two unconscious drug overdoses next. The 24 year-old man is inside a popular gay club and he’s not responding to anything, so he gets ‘Narc’d’ and I give him fluids too but still nothing. Of course Narcan won’t help a GHB overdose, if that’s what he’s had but we have to cover all the bases. By the time we get to hospital, he’s stable but still unconscious, so we leave him in the hands of the Resus team, who intubate him and cart him off to Critical Care for his own good.

A regular caller with abdominal pain (of which he complains a lot) and I’m chatting to a fellow Glaswegian who doesn’t care about anything and tells us which hospital he’d prefer to go to because the other one ‘doesn’t understand my problem’, he claims. They are probably just fed up with him. He’s known to be abusive but I forgave him on the basis that a) he might have genuine pain and b) he’s a Glaswegian alcoholic from the good old days.

‘I thought I was going to die’, said my next patient as she described her abdominal pain and near-faint experience. The 40 year-old had obviously never been exposed to anything more lethal than cotton wool in her life. Her crying Italian mum was making things worse by demonstrating how serious she thought her daughter’s condition was. Both had to be consoled. Both were very lovely people but neither had a sense of the real world.

An 89 year-old woman who fell earlier in the day and was now ‘making no sense’, according to her daughter, was probably suffering the effects of a UTI. The smell was powerfully strong and she had all the classic signs.

A short trip down to The London Eye for a 14 year-old boy with a broken collar bone next. We arrived to find him among hundreds of youngsters who were jumping from heights and somersaulting to the ground – urban free-running it’s called. He’d done a forward jump with a backward flip and landed awkwardly and heavily onto his shoulder, breaking the thin collar bone in the process. The fracture was immediately obvious and it looked serious enough to warrant a couple of stabilising pins in surgery but the x-ray would confirm the severity of it when he got to hospital.

His father and brother were with him; the boy had been wearing absolutely no protective gear when he came crashing down and I could see his father squirming uncomfortably in his seat in the back of the ambulance as I lectured the young lad about how ‘lucky’ he had been considering he’d only damaged his shoulder and not his head or neck. Dad would have to explain this to estranged mum and I didn’t fancy his chances at all.

The last time I dealt with a patient in a taxi he was the driver. He’d had a stroke and was slumped at the wheel on Parliament Square, right outside the House of Commons. Nervous armed cops had approached in case he was a terrorist. He was a Cockney but I don’t think a couple of cops with guns was going to change that. Anyway, my next patient was the passenger of a cab and he had his two young sons with him. He had just been discharged from hospital after having an epileptic fit and had another in the taxi on the way home. His very switched on and amazingly calm sons took care of him and waited for the ambulance to arrive. A FRU was on scene and we took over when the details of his fit were given. He was post ictal and it took another twenty minutes for him to realise what had happened. He was bitterly disappointed to be heading straight back to hospital.

Cirrhosis of the liver is common in alcoholics and my 52 year-old patient had a long history of alcoholism. Now he was suffering generally as his liver began the road to self-destruction. He was unwell – Hep C was exacerbating his malaise.

A strange unconscious call next. A 20 year-old man had been found slumped on Oxford Street. He was completely unrousable, even to deep pain. A solo cyclist was waiting for us when we arrived (although the road works down almost the entire length of one side of the road didn’t help to speed our journey - I had to keep jumping out to chuck cones away) and he explained that the man had been found in this condition by a passer-by who’d bothered to check on him. The patient’s pupils were pinpoint and his blood glucose level was low, so he was given Glucagon and Narcan (for good measure). There was no sensory evidence of alcohol but his possessions gave us something to ponder. He had a bag on him and inside the bag was another bag...a feminine looking bag. Inside that was a store card with a name on it. We presumed that it was his name, of course and proceeded to call him by it all the way to hospital. It was a foreign name and although I didn’t recognise it for gender my brain was telling me it wasn’t a male name. I even asked the attending doctor what he thought of it while the patient was examined in Resus. Everyone was a bit confused about the man’s name and his bag...and the cheap make-up that was inside it.

Now, before you all say ‘it’s obvious’, nothing is in London these days. It could easily have been his make-up and he may well have taken GHB (a popular recreational drug for the gay community) and he may have been on his way home but collapsed as a result of taking the drug. Contrarily, and I began to suspect this and suggest it after looking through more of his possessions – he could have been a bag thief.

Inside the outer bag was another form of ID – a travel pass. This bore a completely different name and a photo, which matched our unconscious patient. Now it was fairly obvious. He had stolen this bag from some unsuspecting lady with bad taste in make-up and had probably intended to get rid of it but had become unconscious in the street – for what reason we still don’t know, unless he had taken heroin earlier on.

If there’s one thing about this city that never ceases to amaze me, it’s the possibility of coming across the most bizarre jobs on a regular basis. I would miss that if everyone became normal.

Oh and the decision to take the FRU's off the road was suddenly reversed soon after I wrote this. Nobody knows why.

Be safe.

Tuesday, 12 August 2008


What goes up...this wonderful piece of grafitti art was pasted onto the wall of the building across from my station but in less than a month, vandals had torn a lot of it away at the bottom and so, down it all came again. I think this photo says a lot about society.

Day shift: Nine calls; four assisted-only, one false alarm, one conveyed in the car and the others went by ambulance.

Stats: 2 ETOH; 1 EP fit; 1 Fall with no injuries; 1 RTC with no injuries; 1 Unwell adult; 1 Muscular chest pain and 1 Suspended.

The day started routinely and ended badly.

My first call was to a 25 year-old male ‘unconscious on a bus’ and we all know what that means. He was drunk and asleep and at 7am when I hadn’t even had breakfast yet, he told me to ‘f**k off’. Still, mustn’t grumble, I had annoyed him into submission and he promptly left the bus. The bus driver looked in with admiration and then said:

‘I couldn’t have done that. You guys are trained for this sort of thing’

I knew what he meant to say but I was crushed at the thought that I’d become nothing more than a specialist drunk waker-upper. I thought I’d achieved a higher goal. I was to find out later on that not everything I do will go according to plan.

Then a 51 year-old epileptic man decided to have a fit in his police cell. He was found lying on the floor by the police officer charged with checking in on him every so often, as they do. ‘Are you alright?’ she’d shouted to him. ‘Yes, I’m just having a fit, don’t worry’, he’d respectfully replied.

His obs were normal and he wasn’t post ictal but he did have a history and I couldn’t ignore the giant, softly-spoken man when he confirmed that he had indeed suffered a small seizure. Who was I to judge? At over six feet tall and just as wide, I wasn’t going to argue with him. My MRU colleague was with me on this call and the crew showed up to take him away.

A call to a 49 year-old epileptic man whose Careline alarm had gone off explained to me that he was absolutely fine and that his power had gone down, thus the alarm was triggered and we were called out automatically. We stood on his doorstep; me fully clothed in uniform – him almost naked and not too fussed about the daylight or the neighbours…or me.

I didn’t do anything at all for the 85 year-old lady who’d fallen and got herself trapped between a wardrobe and her bed. The crew was on scene and they didn’t need a third pair of hands.

A report of a ‘bus vs ped’ meant I was racing towards Charing Cross Road thinking that I may do some good today after all. The bus had clipped a man as he walked across its path (yeah, they tend to do that) but he wasn’t badly hurt and just needed checked out by the crew who arrived before me. The additional MRU wasn’t required either. The man had lost all his beer, however because his plastic bag of booze had been hit, rather than him. You’d think he’d be grateful for small mercies. Still, what a waste.

Off to an hotel (got to say 'an', otherwise the pedants will have a go about the grammar) for a 75 year-old male with DIB ‘? Heart attack’. The staff probably felt it necessary to put that last bit in but when I arrived he didn’t have any chest pain, although he was as white as a sheet. He was with his wife and he denied ever having any DIB but his face was off-colour and sweaty, so he was going through some kind of crisis. He told me he had dizziness and visual disturbances when he exerted himself (this started when he lifted his case from the car to the room). I’ve seen something very similar to this and it rang a little alarm bell. The last case of this kind was a few years ago and I posted on it; the guy had lost some vision in one eye and was very off-colour but had nothing much else to report. He was later found to have suffered a neurological insult.

The man and his wife were quickly packed off to hospital, while the hotel staff helped by carrying one of my bags – it’s like instinct. No tip was offered; I was busy.

The call that ruined my day came next. After initial reports that a 15 year-old was fitting in a playing field, I was sent running on a Red1 ‘CPR being carried out’. I had to call in to confirm this because the call description was confusing – apparently he was still fitting…but that couldn’t be. Either one thing or the other applied and I had a gut feeling that it was the other.

I arrived to find another FRU colleague on scene (by seconds). There was a crowd of about a hundred people gathered around the perimeter of a playing area and I was ushered inside through the chain fence gate. I could see someone compressing a young man’s chest. The closer I got the more I could see that the young man was actually a boy.

I can’t go into specific detail on this call but before long there were three cars and two ambulances on scene and I had taken the reins of the job, so I was trying to co-ordinate airway management, CPR, defibrillation and drugs in an environment filled with people. Obviously, it’s not the first time I’ve done this but when it comes to young people the effort just seems that much more important…much more charged.

He was shocked three times during the attempt and he converted from VF to an agonal rhythm with a very weak pulse – but that didn’t last and try as we could, he slipped back into a pulseless non-shockable rhythm, which lasted all the way to hospital.

I had gone with him and had another paramedic and an EMT with me in the back of the ambulance. Together we struggled to keep him stable but he wasn’t responding to the drugs given or the continual CPR. We had already established that he had no medical history, didn’t take illicit substances and was normally fit and well – he was playing football when he suddenly collapsed, looked like he was fitting, then went into cardiac arrest. After that the story is vague and confusing because I wasn’t listening after the main facts were given by the police officers on scene.

At some point a medical student began CPR with the help of a police officer and a pocket mask. This continued until the first FRU arrived and then we all descended within minutes. None of it made any difference. He was pronounced at hospital after an extended attempt to recover him.

The call knocked the stuffing out of my day because the patient was so young (he was actually 18 years old) and because there looked like a chance in hell at one point but it slipped away.

After that I had to persuade an unconscious drunken Pole to get to his feet and wander off to a less public place than the middle of the pavement to sleep. This was followed swiftly by a 37 year-old French man who said he had chest pain but it soon became clear that he had nothing more than a muscular problem, so I took him to hospital myself. I loathed the idea of an ambulance being tied up on this one while another teenager possibly lay lifeless on a playing field.

Be safe.

Monday, 11 August 2008

Too late for some

Day shift: Three calls; one hoax, two by ambulance, including a running call

Stats: 1 Neck injury (fall); one ETOH

Interesting to see that the media are now getting all excited about the fact that alcoholics are using Spirigel to feed their habit. Not only do they use the word 'anecdotal' to describe the evidence but they still seem to believe it hasn't yet been experienced by many of us out there. If only they'd read what I wrote more carefully, eh? I haven't seen my Polish frequent-flyer for some time - I suspect he may have succumbed as a result of his gel-stealing. I warned him many, many times.

Trafalgar Square is my stand-by point and it’s usually a pleasant place to be, especially when the weather is nice and there are lots of interesting people around. Today, however, the tourists, Londoners and myself were treated to some light entertainment when one of the local alcoholics started threatening someone with a broken bottle. When the cops arrived I watched as he aggressively abused one of them too. The cops were PCSO’s and so when the real thing arrived (no offence to the PCSO’s) en-masse (three vehicles and a van turned up), he was eventually subdued with handcuffs and a quick drag to the lock-up. Too right.

I was cancelled on the first call of the day for a 35 year-old man with a neck injury who had fallen from scaffolding, according to the call details. I phoned in to see if I could be useful because I was only a minute or two from the scene and it takes at least two people to deal with a proper neck injury, if that’s what it was. I was told that a bike had already been despatched but I was still concerned about the nature of the call and the fact that only one person had been sent.

I was re-sent the job (apparently I was closer after all) and sped to the scene. I found myself in a construction site and was led up three flights of half-built stairs and along what seemed like endless corridors to a first aid room. This surprised me because I had expected to be taken to the bottom of scaffolding on site – I had my hard hat on and everything.

The patient sat on a chair with a collar on. This was my second surprise. The duty nurse had placed it after the man had been brought to him – he had walked down stairs to get here and complained of neck pain – well, no wonder, I thought. Apparently he’d just smacked his head on the scaffold as he climbed down. This sort of accident had happened before, I was reliably told by the nurse, and the last patient had to be lowered down to ground level using a Neil Robertson stretcher.

My MRU colleague arrived after a few minutes and I explained what was going on. Soon the crew was with us too and we planned his route out - over a period of time, I can tell you. The place was a bit of a maze. Nevertheless, the clever crew managed to get the trolley bed up in the goods lift, despite the fact that this 'couldn’t be done', according to the nurse. The patient’s neck was immobilised properly and he was put on a board using our rapid take-down technique, which involves lowering him from a standing position until he is flat, without him having to make a move himself. We don’t have to do it much but short of putting him in a KED and taking him down on a chair, this worked just fine.

There is always a risk of compression of the spine when you stand up and smash your head on some unyielding object, like a scaffold cross-bar, so we weren’t taking any risks; neither were we taking him down on a Neil Robertson (there was one laid out on the floor for us).

It took us almost an hour to complete our mission but it was managed and he wasn’t in too much pain. He had all his necessary sensations and movements, as per our ritual checks and he was very calm…and why not, he’d walked himself to the first aid room, hadn’t he?

When I got out and had to park up elsewhere and complete my paperwork, the friendly, helpful workmen did this to my car...for protection they said.

My hoax call was for an unconscious female on Trafalgar Square. I think someone must have seen me in the car and decided to dial 999 for a laugh. The call had been made from a local box, so whoever it was must have sloped away and watched as I searched the area with a bewildered look on my face.

A Polish nurse friend of mine was chatting to me when I got my last call and ironically not only was it a few yards from where I was but the ‘unconscious’ male just happened to be Polish. She hadn’t believed me when I told her that we see a lot of her countrymen drunk on the street but I think this took her by surprise. I asked her to help with translation and she went on to have a full conversation with him until he lumbered onto the ambulance for further checks. He’d been seen lying sparked out on the pavement near the Portrait Gallery – he was only nineteen but already he knew how to mimic his elders.

I have to say that I have great respect for the Poles and I mean no harm when I talk about individual nationals like this. I have been just as scathing of the drunken behaviour of my own countrymen but there are fewer of them around these days. They’re probably all lying in the streets of Poland.

Be safe.

Friday, 1 August 2008

Teen trouble

Day shift: Five calls; one assisted-only, four by ambulance.

Stats: 1 TIA; 1 HepB; 2 Faint; 1 Frequent flyer with odd excuses

Transient Ischaemic Attacks (TIAs) are calling cards for stroke – they are ‘little strokes’ if you wish, caused by a sudden decrease in blood-oxygen supply to a small part of the brain. Multiple TIAs are fairly common in people prior to the big one.

My first patient of the day was a 53 year-old man who woke up in his hotel room bed, unable to move his right side properly. He had lost power and some feeling in the limbs and had speech problems caused by a cranial nerve dysfunction. He noticed his speech was slurring when he made the emergency call.

We carry out a FAST test on suspected neurological patients and this basically involves checking for power, sensation and co-ordination. This man’s test was positive for ‘arm drift’ and ‘crooked smile’. He knew himself that things weren’t right. He was a stoical German type and kept repeating solemnly ‘this isn’t good’. I put him into a more positive frame of mind by reminding him that he could recover fully from his predicament.

Drug addicts are more prone to Hepatitis B than most of the population because they are in a higher risk category for exposure. My next patient, a 41 year-old ex-heroin addict (he’d been using since he was 16 years old) rolled about in agony on a chair at the hostel he lived in. He clutched his abdomen (this call was given as ‘chest pain’ incidentally) and moaned about the pain he was in. He was a very skinny and very sweaty individual with a history of HepB and a recent inoculation of the C variety. He didn’t look very well and it was obvious that his illness was giving him problems. He’d dined on a concoction of Methodone, Valium and Cocaine the night before, so he left a little room for differential diagnosis.

His BM was low, so a liver-related problem was more likely and off he went to hospital, although he dithered and stopped a few times along the way to drink something, grab ciggies and chat to mates about how miserable he was – funny, they all seem to do that.

Pain causes some individuals to faint and I guess that until I have experienced truly agonising pain, I won’t know for sure if I am one of those people but I doubt it. I tend to stomp around smashing things instead – it doesn’t relieve the pain but I get my own back on inanimate objects that have always annoyed me. The last time I did that was when I had a nasty tooth abcess.

So it was with my usual smiley, happy-to-see-you face that I greeted the 32 year-old female who’d fainted because she had back pain. Another German person determined to play it down. She was fully recovered by the time I arrived and, after the crew gave her a quick on-the-spot check, she was left at work to continue her day. She asked for my phone number. I smiled but didn't give her it - I'd be in trouble if I did :-)

My second faint of the day was a 40 year-old man who collapsed inside the toilets of his workplace. He lay there feeling ill as I tried to get to the root of his problem. He was pale and shaky but he seemed to be recovering well enough. He had no medical history of significance and had fainted once before, so he knew the score. He told me he was dealing with a lot of stress at work (who isn’t these days?) and that he hadn’t been able to cope very well with it – evident from his current situation.

He was taken to hospital and actually started to look even more ill as he was trundled through his workplace by the crew.

I spent a short time in Wells Street, W1 after that doing my paperwork and I noticed a little pub called Ben Crouch’s Tavern sporting a sign claiming that it had a ‘spooky atmosphere’. I’d like to visit it one night when I’m off duty but if any of you guys get a chance before me, send me a report. Also, let me know what the prices are like.

Just as my day looked routine, I got a call to attend a 15 year-old boy who’d ‘passed out’ several times in the street. I got on scene and he was waving at me from a call box, looking well enough to walk. I couldn’t understand a thing he told me and there was nobody else with him. He didn’t know his age or his date of birth and was vague about where he lived. This concerned me and I was relieved when the crew arrived because I didn’t want to be on my own with this kid. His behaviour was strange and he made no eye contact whatsoever. I don’t trust anyone who doesn’t make eye contact.

While the crew chatted to him (gaining no new ground) I called for the police to attend because I suspected something wasn’t right with this boy but the cops were busy dealing with a firearms incident and couldn’t get there ‘til much later. Great.

I didn’t want the crew going off on their own with him because that would mean the attendant would be alone in the back of the vehicle with him and God knows what he’d come out with (the boy, not the attendant). I agreed to travel in the back as well, so there were two of us. He’d already said something spurious about a man talking to him and suggesting things to him and that made me nervous about his state of mind.

I managed to get his mother’s contact number, one of only two that he stored in his mobile ‘phone (who has only two numbers in their phone?). Ironically, the other number was his.

I called and called but there was no reply. Then, as we were preparing to set off after twenty minutes of getting nowhere with the boy, his mum called me back but she was evasive and gave very little information. She asked which hospital he would be going to and that was pretty much that, despite my enquiry as to his mental health or if he had learning or behavioural difficulties.

We got him to hospital whilst he repeatedly reminded us that he wasn’t mad, not that any of us had even suggested it and I found out through a colleague who just happened to call me that he was a known frequent flyer from her sector and that this was exactly his M.O. – he loves the lights and sirens apparently and calls the police and ambulance services out to appease his desire. Someone’s mum needs to have a really long chat with someone I think.

We left him in a cubicle, after having to catch him several times as he wandered off at random in the hospital. The nurses could take care of him now and I hoped never to see him again. I hoped he’d return to his usual stamping ground…we’ve got enough of our own down this way, thanks very much.

Be safe.