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.


Anonymous said...

for what its worth i think you all do an excellent job having had to call you for my mum and had your colleagues called out for myself.

time wasters are an abomonation on society. maybe making them face people that that need your services who don't recieve them quick enough because of them is a way forward similar to making jeuvaniles meet hardened criminals. you never know it might work.

manu said...

medics rule! 23yr old headache guy should just be slapped silly...

Paul said...

Hi, I got your book after coming across it in waterstones, its brilliant. Given that I work in the same sort of area (I do first aid at events for the Red Cross) I found it quite interesting.

Glad to have found the blog too

Anonymous said...

Regarding the motorcyclist.

How does putting someone in the recovery position increase the risk to a patient? Or am I reading something wrong?

Anonymous said...

When you have an apparently limitless pot of sweets, free to all, you will always have some that crowd around, eating as many as they can, pushing hungry people out of the way.

The price of sweets is forever going up, and peoples greed is insatiable, yet increasing.

I know the little old lady argument, but we cannot continue have the NHS free at the point of use any more.

Especially for a headache. Why did you let him lean on you? I'd have been tempted to show him what a real subdural hematoma is like with a 5lb lump hammer...

Anonymous said...

The motorcyclist may have had a broken neck. Taking off their helmet and moving them around is a risky thing to do - they could end up paralysed.

Someone should only be put in the recovery position when they are unconscious, and they are in danger of choking on their own tongue.

If you come across an accident like this, unless they aren't breathing, leave well alone!

louise said...

hi, i read your blog every day, and noticed you havnt written for a while. i hope you are ok,
as a christian i always say a prayer for the emergency services as i think you all do a brilliant job. i dont know you but you have been on my mind, and i am saying an extra prayer for you today.
keep safe and take care.

Xf said...


That might work but it would probably violate their human who cares about ours.

Xf said...


Welcome aboard!

Xf said...


If there is a neck injury (or another serious injury), moving the patient may cause more harm than good. Only move patients into the recovery position if they are unable to maintain their own airway...that's the whole point of it.

Xf said...


I agree and your pot of sweets analogy makes sense, especially in our current economic climate but we need to think it through.

Xf said...


I'm not religious, as you probably know but I thank you for your thoughts and for spending the time to pray.