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.


gjmoomin said...

A lucky little girl - those shoes should be banned. They are dangerous on different floor surfaces too. They have become very popular amongst care staff in my place of employment and one unlucky person has just had 16 weeks off sick having tripped over her own feet and fracturing the radial head badly enough to require two operations, leaving her with very limited movement and us questioning is she still fit to do the job. Needless to say a new policy on footwear has appeared. Readers beware!
Take care. Gill

Anonymous said...

In your last paragraph you mention the lack of care of MOPs. In my opinion as a MOP I don't want to interfere if a medical professional is on the scene. It seems we're damned if we do and damned if we don't... if we try and get involved then we are 'rubberneckers', if we don't we are insensitive. I 'll jump in if someone's in trouble, but if an ambo is on scene then I'll steeer clear and leave it to them.
I'm not a 'walk by' though, I've jumped in on a serious car vs ped RTC and felt the helpnessness of watching someone dying in front of me so I don't know the best course...

John WH said...

Public reaction to illness. A friend doing First Aid in a theatre was called to a 'collapse-with-chest-pains' in the centre of the Circle. Conscious, but clearly he had suffered a heart attack. Whilst they awaited the Ambulance, other members of the audience continuously complained about the obstruction to their view, and asked the First Aider to sit down.
(She didn't!)

Jake said...

Regarding the chest/abdominal pain question, at what point do you consider the chest to stop and the abdomen to begin? When I get the odd twinge of heartburn (which I have never once mistaken for imminent cardiac arrest, but that's by the by), it seems to be centred on the base of my sternum.

Jen said...

I work in a supermarket and some of the things that people do when others are ill there frightens me.

There was an incident where someone had collapsed (a MOP) and everyone else was stepping over him to continue their shopping.

Another time, someone had fallen and injured their head - there was blood everywhere. An ambulance arrived and while the MOP was being treated, the managers closed off the aisle to give the patient a bit of privacy. That didn't stop the other MOP's complaining that they wanted something from that aisle. Never mind that there was someone with a head injury lying there!

Xf said...


If you read what I wrote you'll see that I was commenting on their lack of interest in terms of giving us space to care for her. I don't want people interfering with patients at all if they don't know what they are doing but I want them to have the common decency NOT to push and bump and jostle a distressed young girl as they fight to get to their food.

Xf said...


The diaphragm is the muscle that separates the two cavities, so the chest ends at that margin. Anything below the diaphragm is in the abdominal cavity; stomach, spleen, liver, kidneys, bladder, etc. etc.