Tuesday, 28 October 2008


Night shift: Four calls; all by ambulance.

Stats: 1 eTOH; 1 ?TIA; 1 Unwell baby; 1 Assault with eye injury.

Sundays tend to be quieter and I took advantage of the downtime at the station. I might as well because every weekend from now until next year will gather momentum in terms of call volume. We are taking around 4,000 a day at the moment.

So, in typical fashion, I was cleaning up the dregs of Saturday with a drunken Spaniard who went to sleep at a bus shelter. He spoke no English and his fractured bottle of Chivas Regal gave away his hobby. I cleared the litter and then stood him up. The crew arrived and he was taken off the streets. So we cleared the litter twice.

Botox, funnily enough, can numb the face. A call for a 48 year-old female who lay in the corner after a party in which hundreds of people milled around, claimed she couldn’t feel one side of her face (the side she’d had treatment on). She was drunk and told me she had high blood pressure, which I didn’t doubt. Her anxious friends kept getting in the way and the shy patient told them she wanted the room cleared before she’d move for me. That wasn’t going to happen and when the crew arrived she was taken away in a chair in full view of everyone.

Now, having said all that, Botulinum can cause problems if it travels down nerve pathways and into the brain, so the woman may have been suffering a genuine neurological insult and doubtful as I was, given that she was drunk and her behaviour was more of an embarrassed inebriated person rather than a stroke victim, there’s no room for error on assumption.

Unwell children are among the worst type of call and I always worry a little about the condition a child will be in, regardless of the call description. Regular readers will know why. So, a call to a 20 week old baby with DIB had me thinking the worst. The little girl was currently being treated for an infection and rash and now she had diarrhoea and her breathing was laboured.

The parents stood by as I climbed over the makeshift bed on the floor of their flat to examine the child. She was sleeping and I felt guilty waking her up. I felt even guiltier piercing her tiny foot with a needle in order to get blood for a BM. She was active and her breathing seemed fine, if a little fast. The crew took her to the hospital where she’d been born – they’ll have more information about her there.

I stood by in Soho for a while but I moved off after a prostitute approached the car and asked if I was Mike. I told her I wasn’t. ‘Is Mike not on tonight then?’ she asked. I know several Mikes at work but I doubt she knew any of them. ‘Well, you look like Mike’, she said before bidding me a good night and wobbling off. Things are a bit tight if they have to resort to picking up emergency service personnel on duty. I expect she hit on a cop next.

Another eye injury tonight. A 49 year-old man was assaulted on a bus with a weapon and his left eye was so badly damaged that blood had entered the space in front of the eyeball. This condition is known as hyphema and it isn’t always sight-threatening. In fact, I couldn’t see this problem because it was dark and he had a wound above the eye which needed covering, so I learned about it from my colleague on the ambulance that took him away. He had told me he couldn’t see but that could be temporary. Hyphema can clear up on its own but it depends on the extent of the damage and the treatment given.

While I was trying to treat him, he insisted on getting up to go. Only the cops on scene could contain him because all he wanted to do was get revenge. He obviously knew his attacker and he was hell-bent on going after him. This is how things get out of hand and people get stabbed to death.

Be safe.

Monday, 27 October 2008


Night shift: Eleven calls; one no-trace; one false alarm; one declined and the rest by ambulance.

Stats: 1 Faint; 1 Abdo pain; 3 eTOH (including assaults); 1 Assault with head injury; 1 DIB; 1 Unwell.

The weekend continues with an assortment of calls, including the usual suspects involved with alcohol.

The no-trace was for a collapsed 40 year-old male who didn’t exist when I got on scene. A witness had called us but declined to stick around – that always looks dodgy. The police arrived a few minutes behind me but the guy had either walked off after his sleep or he hadn’t taken up pavement space in the first place.

A first aider from a theatre ran out looking very worried and said ‘hurry up, she’s getting worse!’ and so I asked Control to speed up the process if possible, thinking that my 45 year-old female patient who’d fainted was having a cardiac event.

Once inside, however, it was clear she’d just passed out and was unwell with the heat of the place. She told me she’d been experiencing hot flushes and at times felt cold. Her hands were tingling (probably because she’d been hyperventilating) and she had abdo pain to start with. I asked her if she was menopausal and she confirmed that she’d just started it. This was probably the culprit but she was taken by ambulance just in case. Meanwhile her friends were digging her because they’d only just arrived to see the show and now they were going to miss it. There was good humour in their comments though.

Another abdo pain in a restaurant next. A 54 year-old woman passed out after complaining of stomach pains. I found the place after negotiating the terrible road closures around the Covent Garden area – the poor woman and her partner were left sitting in the basement for a long time before I got there and none of the staff even asked if she was alright. I had to find my own way down to her.

Her BP was low, so she was laid down for a bit until it recovered but once the crew arrived and her ECG was checked I found a couple of anomalies and thought it would be best if she went for a check-up.

A suspect vehicle was found in Mayfair, close to an Embassy, so I was asked to attend the RVP with a crew and a couple of other resources as the police explosives dogs sniffed around the cars in the little side street. There were at least ten vehicles on scene, including the specialist bomb team whose truck houses an explosives robot. The lorry had been seen parked there for hours and a couple of PC’s weren’t happy with it, so we were all unleashed to the area. Plenty of people in the local buildings found the scene entertaining but they must have been concerned about their proximity to all this activity.

We were stood down after 30 minutes when nothing was found. A lorry driver is going to get more than a ticket when he comes back.

A six foot plus Norwegian man was allegedly assaulted in the doorway of his hotel and he lay on the carpet completely confused. He had blood coming from his lip but no significant injury and I spent some time trying to persuade him that he should get checked out. A witness told me that he’d seen him ‘flying’ through the door and I reasoned that if he’d been punched it would have been by someone at least his own height. The possibility that he had just tripped awkwardly seemed more likely. He was very, very drunk.

In the end, after the police had arrived and a crew was on scene, he was taken away by a friend who said he’d look after him.

Two young girls were assaulted in a Soho night club by a man when he took offence to them. ‘I don’t care if you are a man or a woman’, he’d allegedly said to one of them just before he head-butted her. Then he smashed a glass over the head of her friend who tried to defend her.

When I arrived a couple of doormen were pinning the guy to a wall outside, waiting for the police. His girlfriend was with him…she must be very proud of her man.

Another young woman was left abandoned by her so-called friends when she became too drunk to stand. She vomited all over the toilet floor and passed out. I arrived to find her bent over a sink feeling sorry for herself and apologising to me for the trouble she was causing. I asked the ‘booze bus’, which is running every weekend, to come and collect her. She didn’t have enough money for a cab home, so she would spend the night on the good ship NHS until she was fit for the bus.

A fight broke out on the Embankment and two 28 year-old men were given head injuries. One of them, in an attempt to escape across the busy road, slammed into a car. Both had no memory of being hit and both needed to go to hospital, so I needed two ambulances for them. I was draining our resources single-handedly this weekend.

There was a bit of aggression between them and another man and I was caught in the middle of it. For a moment I thought I might get myself punched just for being there in the wrong colour, so I made my usual de-fusing speech and things calmed down as I treated the men’s injuries.

For an hour or so I bantered with the crew of the booze bus, which I love dearly, in Soho, where they park up and wait for calls. I had time to laugh and relax with coffee for a change.

I wasn’t required for the DIB outside a hostel because the crew arrived with me, so I left them to it.

An unwell 37 year-old woman who said her heart was ‘fading’ prompted an emergency call at her workplace but the more we spoke to her (crew on scene), the less I believed her. She had no medical problems at all and seemed to be tired. She wanted a night off work I think.

My last call was for a 19 year-old woman with sickle cell crisis but I didn’t see her because the crew arrived with me and I let them get on with it. Thus my Saturday night passed into the annals of history…until the next one.

Be safe.

Sunday, 26 October 2008

Friday in Hell

Night shift: Seven calls; one assisted-only; six by ambulance.

Stats: 1 Chest infection; 2 Stabbings; 1 eTOH/drugs; 1 eTOH fall with facial injuries; 1 eTOH; 3 Assaulted with head injuries.

Friday night and although I’ve written up seven calls, there were more but I’m too tired to record them all. I had an observer with me tonight – an LAS bod from Admin called Scott. This was his first trip out in a Fast Response Unit. Probably his last after he’d witnesses a typical weekend starter.

A Red1 for a ‘choking’ was in fact nothing of the sort – the patient, a 77 year wheelchair-bound lady had a chest infection but her call for help somehow translated as life threatening to the Careline people, who tend to panic if not sure. The rapid trip to the flat was complicated by our (the crew was on scene with me) inability to find the exact address given. We ran into a block of flats with the worry that we’d left a potentially dying woman behind locked doors too long to save her. There were no police units available to assist us should we need to force the door and I intended to do just that if we found there was no way in.

Unfortunately the block we’d gone into didn’t have the relevant flat in it, even though the buzzers listed it. We’d gone past the little gate that opened into the patient’s home and when we found it we knocked loudly. There was no reply and I tried the door. We’d been told it was locked but it opened right into her front room and there she was…sitting in her wheelchair with a surprised look on her face.

‘I thought I’d locked that’, she said.

‘We were told you were choking’, I said.

‘No, I’ve had a bad chest infection, that’s all’.

I left the crew to deal with her and I met the police, who were running towards me in panic mode. I told them it was a false alarm and they wound themselves down to catch their collective breaths. It was a punchy start to the shift.

A 19 year-old man was stabbed in the back of the head for no apparent reason as he walked through a busy West End street. I say no apparent reason because his behaviour as I dressed his wound, which was deep enough to require stitches, was shifty to say the least. Police were on scene and his answers to questions like ‘what’s your name’ and ‘where do you live’ were delayed and vague. He made no eye contact and continually looked about as if he was late for something…a gang meeting perhaps. Very judgmental of me, I know, but that’s how it felt.

After he’d been treated a man appeared at the corner of the restaurant where the patient had been, fiddled with his belt and positioned himself at the corner, near the entrance. I knew what was coming. Bearing in mind that the police were right there with me, interviewing the victim and the place was heaving with people going about their night’s business, I felt sure he wouldn’t have the bottle to go through with his next action…but he did. He unzipped his fly and began urinating right onto the pavement in full view of me, my observer, the police, CCTV and hundreds of others. It was only when I asked the nearest police officer to intervene that he was noticed.

‘What are you doing?’ asked the cop.

‘I’m pissing, what does it look like?’ replied the drunken and obviously stupid man.

One of the plain clothed police officers turned to him as he continued his acidic waterfall display and asked ‘do you think that’s alright then?’

The first officer then added ‘your lucky I’m busy with something more serious at the moment’.

The man shook his weapon of mass destruction and grinned. It was the grin of an idiot on patrol. Then he buzzed off after several more warnings from the cops. It was moot because the damage had been done and a little river of urine travelled towards my boots, which I deftly lifted out of the way after a quick warning from my observer (who was very observant, obviously).

The eating customers in the restaurant had not only been treated to the sight of the man with the gashed head, they’d also had a special bonus treat and got to watch Mr. Urinator do his thing for them. Cool.

I waited a long time for an ambulance on the next call. I was with a 40 year-old woman who’d been found collapsed, apparently drunk, on the floor of a club. The security people had dragged her outside (they do that) and left her on the pavement for me to collect – like rubbish.

At first she did seem drunk but her behaviour wasn’t consistent with just alcohol and I found out she was a nurse. Her boyfriend was with her and he was an EMT, so it was a big family get-together for medical types, except she wasn’t enjoying it. Her breathing was laboured and stertorous and she stopped and breath-held every now and again, for reasons I cannot explain. It wasn’t respiratory depression, she just wanted to stop.

Meanwhile a small, wide black woman from the crowd was shouting and swearing and making a real nuisance of herself, claiming that her mother was a nurse and that she knew what was happening and that I didn’t have a clue. She stood over the head of the patient just at the moment I noticed her breathing stop again and she obstructed me so much that I couldn’t move to reposition her in order to assist with her airway. This kind of obstruction is illegal now but the mad midget had no intention of letting me go about my business without putting herself in the frame.

I asked the door staff to help me but they were stopped in their tracks when she belted out ‘you can’t touch me, that’s assault’. She was eventually shepherded away by someone else, a man who became quite abusive towards her and who was hell bent on punching her lights out. Unprofessionally, I thought it would be a good idea.

Now my patient was floppy and her breathing wasn’t good, so I put oxygen on and prepared for the worst, although I still felt she was over-playing this. Her boyfriend remained strangely calm about it all – this was only their first date and I doubted he’d be inviting her out for another.

I called again and again for backup until I was forced to ask for urgent police when the mouthy woman from a few minutes ago returned to my horizon. She made racist comments about me and generally insulted me. I’ve never been called a bitch before, it was a new experience and I didn’t quite know what to do with it. All I could hear, despite the presence of dozens of other noisy people, was her shrill crackling voice as she berated me. I’d never met this lady in my life before. I must have done something to her in my past life…perhaps when I was a practicing psychiatrist.

Almost an hour past and the police had arrived and contained the little horror south of me and my patient. I could still hear her arguing with them. Now she was telling them her relative was in the CID and she knew lawyers too. I was gobsmacked that she had any siblings because I’m quite sure they would all have topped themselves after ten minutes in her presence.

The ambulance arrived and a Station Officer landed to give me backup too. I left the DSO to solve the little matter of the poison pixie while I concerned myself with the patient, who was still in bad shape. The crew took her away and I followed on but before I left I witnessed the police being harangued by the wicked witch to the point that they looked very tired of it all. They weren’t even going to do the paperwork for her and advised her, in the strongest terms, to leave the scene. She sloped off, shouting all the way, to the underground station where she would no doubt have entertained many people all the way to wherever she came from. Hell’s my guess.

Later on I was told that the naughty nurse had discharged herself from hospital with nothing wrong except too much alcohol in her blood. She’d been playing it just as I had suspected.

Outside St. Thomas’ hospital a little criminal, escorted by two big police officers, attacked them both as they took him away. He belted one of them so hard he hit the ground and all I knew of this was the frantic run up the ramp by one of the officers when he asked a crew for help. I drove down behind the ambulance and the poor cop was on the ground with a bruised face and a broken ego. The other cop was pinning Mr. Nasty to the pavement. How can a man like that possibly contribute to society?

It’s refreshing to know that we aren’t the only people that patients can make look like fools. A 35 year-old man who fell (drunk) and smashed his face was sitting with two PCSO’s in the street when I arrived. ‘I can’t get a word out of him’, one of the officers said as I knelt beside the bloodied patient.

‘What’s your name?’ I asked.

‘Mike’, he replied without hesitation.

That left the PCSO looking bewildered.

Then three young soldiers were set upon in W1 by a gang of youths; I watched as police vehicles, one after the other, raced towards the scene until I was called to attend. Each of the three had head injuries and one was laying on the ground – he had suffered the most. Weapons had been used and the patient on the deck described them as ‘batons like the cops use’. His two mates were wandering around as the police tried to contain them and, most unhelpful as usual, a female companion was dramatically running among them, crying and shouting out as if the whole world had ended for her.

I asked for two more ambulances and we got all three to hospital, especially my patient on the ground who had to be collared and boarded. The least injured was taken in my car because I only got two ambulances in the end.

Another assault in the early hours and I carefully approached a small car with steamed up windows because there were a number of people inside and I wasn’t entirely sure of my safety. The call had described a patient ‘bleeding from the eye’ and when the driver’s window was wound down at my request I could see four young black girls in the vehicle. One of them, in the driver’s seat, was holding her head as if crying. She had been attacked and the assailant had thrown her to the ground, kicked her and stamped on her hard enough for the heel of her shoe to pierce her eyeball. I had a close look at the damage and I’m sure she’ll have to live without sight in that eye now. She is only 19.

A drunken Chinese 21 year-old ended my shift. He lolled on the pavement, surrounded by his noisy, photo-taking friends. Every time I tried to carry out obs on him he’d thrash out at me and the crew that arrived decided enough was enough and called the police. They subdued him eventually and we dragged him onto a stretcher as he slumbered in alcohol-land. He needed a big needle and fluids and I obliged.

Be safe.

Saturday, 25 October 2008

Unwelcome sight

Day shift: Twelve calls; one assisted-only; four cancellations; one treated on scene; six by ambulance.

Stats: 1 Chest pain; 2 Faint; 1 Assault with back pain; 1 eTOH; 1 Cardiac problem; 1 Inhaled foreign body; 1 Hypoglycaemic.

Well, the first two calls – a chest pain and a faint, aren’t worth noting because I didn’t do anything. Indeed it was a day of cancellations either when or before I got on scene. A frustrating sort of day then...

Until I managed to secure my place in today’s history by attending the 30 year-old lady who was pushed to the ground by a complete stranger. Now she had back ache. The motive for this vicious assault on a busy street in broad daylight is a mystery but the description given by witnesses of the man who perpetrated it seemed to match a regular street person with mental health issues that I knew.

The patient was only five feet tall and her assailant came from behind at speed and simply brushed her aside like she was an irrelevant obstruction. He was much larger and stronger than her, so when she fell, she crashed to the ground violently, hurting her back in the process. The witnesses were appalled and, even though they had places to be and things to do, they stuck around until the police had arrived in order to give statements and accurate descriptions of the man to blame. Whether the offender will be caught and punished is one of those lengths-of-a-piece-of-string questions.

Posh hotels (4 star and up) don’t really enjoy our company – we make the places look bad and the quicker we are out the better. In general, they are very nice to us but underneath the chat and smile you can detect a growing concern that their guests from the upper echelons of society may not take too kindly to staying in a place where people get ill or die. It’s sooo common.

So when I appeared in the room of a 33 year-old man who was ‘unresponsive’ and surrounded by hotel security I instantly felt at home with the edited responses to my questions. The man had been dumped at another hotel, allegedly by police (I find that unlikely) and then carted over to this hotel when his room key was found on him. He was completely out of it.

‘So, if he was brought over here how did he get to his room and onto the bed?’ I enquired.

‘We got him up here in a wheelchair’, replied the tall, beefy, dangerous-looking security man (‘security man A’ I shall call him).

‘Oh, right. So he arrived here in this state and you called an ambulance after you moved him to his room?’ I knew I was treading thin ice with a loaded question but I couldn’t resist. I don’t get many opportunities to be patronising with someone as large as security man A (I shall now call him SMA, for the sake of abbreviation – I quickly tired of the last name I used).

They didn’t want him seen in their foyer, you see. It was early morning when he was dumped on their doorstep like some adult-sized, drunken newborn and the guests would soon be at breakfast. There was no way on Earth they were going to leave him where he was until we arrived – we are just too unpredictable; we might have taken hours to get there.

Anyway, the crew arrive and I explain the problem. He’s rousable but not with it. We’ve ruled out diabetes, other medical problems and drugs…mostly because he’d been out all night with his friends (where they were nobody knew) and I pulled a full miniature of vodka from his pocket. So he was drunk and intact BUT not fit to stay here. He hadn’t been robbed and he hadn’t been assaulted but I requested the police because it was all too suspicious for me. The security men (including SMA) didn’t like that one little bit.

We cart him off to the ambulance and the police search his pockets more thoroughly than I’d dared, just to make sure there was nothing untoward going on. No drugs were found, no evidence of robbery (he had his money and phone with him) and no evidence of assault. So we were very sure that he was just drunk.

We managed to get him off the premises and out of sight just in time and for that SMA was grateful. I’m sure that’s why he thanked me as we left the red carpet behind.

A very unwell looking 35 year-old with a Mesenteric aneurysm, DVT and valve replacement history and a dodgy double-beat on his radial pulse had to go to hospital fairly quickly. A pulse couldn’t be detected on his other wrist and he was feeling ‘strange’. He may have developed an infection or his aneurysm was about to go ‘pop’. We couldn’t tell but we weren’t taking any chances with him. His blood pressures were wildly different from one arm to the other – not a good sign and possibly indicating an obstruction an the artery on one side. The MRU, myself and the crew all agreed to scoot ASAP.

An embarrassed 45 year-old lady asked me not to bother with an ambulance because she’d just given blood and fainted in a cafĂ© as her worried friend looked on. He was the one who called the ambulance. She didn’t want the fuss. Neither did I. I told her I knew where I wasn’t wanted – she smiled and so did I.

But the 39 year-old crack-smoker who inhaled a piece of the metal upon which his delicacy was being cooked certainly needed me. The doctor who called us wasn’t too impressed with my ‘casual’ attitude. He’d asked for a blue light response because he was concerned that the patient’s airway would swell up and he’d die of asphyxia. Admittedly, the patient was a bit croaky and he had trouble swallowing but apart from that I saw no reason to rush into worry mode for him. I even considered taking him to hospital in the car such was the stability of his ‘condition’.

The small piece of metal had lodged in his throat somewhere to the right and just south of his pharynx and my best guess was that it affected his oesophagus more than his trachea. Okay, it had gone in red hot and he’d smelled burning flesh and had been in some pain initially but now that it had cooled, there was no imminent danger in my opinion. It was an accident that could have happened to any of us I reasoned. Well, any of us who use crack and have an unusually powerful suctioning action when smoking it.

He walked out to the street with me to wait for the ambulance because the doctor, who worked in the little surgery in the same building that housed the addicts, was making me feel uncomfortable. I think he took exception to my line of questioning and the presumption thereby that I thought he knew nothing of the matter. I just wanted a hand-over and I wasn’t prepared to get hyped up about it, that’s all.

I’ve said it before…sometimes saving a life is easy. A 27 year-old prop-hand and known diabetic was slumped in a chair at the back end of a theatre after collapsing during heavy lifting, which is his job. His boss and colleagues felt he must be hypo and called 999. I arrived, sussed out his BM at 2.1, gave him an injection of Glucagon, fed him on Lucozade and watched him slowly recover to 5.4 over a twenty minute period. See, easy.

He was left with a couple of donuts and after I’d done the paperwork, I saw him smoking a ciggie and leaning against a wall outside. ‘I’ve no idea why that happened’, he moaned, ‘I’m usually good at keeping my BM up.’

I believed him because most diabetics do their best to keep their condition under control but as they get older, more tired and more inclined to over-work, the delicate balance is ruined and a re-assessment of life is required. This was his second hypo in as many weeks and his boss promised him a lecture when I left.

After that, even the calls were rejecting me. I’d already had a day in which I felt unwanted by the public and professional faces I’d seen – now I was sent four calls and four cancellations in a row. I limped back to station wondering if Scruffs would turn his nose up at me when I got home.

Be safe.

Friday, 24 October 2008

Dying alone

Day shift: Five calls; all went by ambulance.

Stats: 1 Asthma; 2 Faint - 1?cardiac; 1 Cardiac arrest; 1 EP fit.

A 71 year-old asthmatic with COPD began to have breathing problems four days ago and went to his GP. The doctor told him to go away and call an ambulance (allegedly). I arrived four days on, when he’d decided to give 999 a try, to find him in trouble. The lovely little Indian man held my hand as I walked him back into his flat (top floor, last flat) and sat him down. His breathing wasn’t good and his sats were low. He seemed to warm to the female member of the crew and didn’t need much persuading to go with her to the ambulance. Even at his age and with his present condition, he was able to flirt with the opposite sex. I hope I see that day myself at 71.

If you have a pacemaker fitted and you keep passing out, you might need to have the device checked. The 88 year-old man lying on his toilet floor had fainted suddenly while chatting to his wife (I have no idea why he was in the toilet with her). He tried to faint again when we tried to move him to the chair, so I think his pacemaker is due for a service. Either that or he has developed another problem. He never looked less pale even when he claimed to have recovered a little, so off he went as soon as we could keep him stable enough for the short trip to the ambulance.

A Red1 in Oxford Street and I arrive just behind the MRU. I run in with the equipment I think we’ll need and I find the staff surrounding the bottom of the escalators – a human screen alongside a medical screen. Behind it an 82 year-old man lay on the floor with a head injury after falling down suddenly. He was in cardiac arrest. My colleague had started attaching the defib and a couple of volunteers; first aiders from the store, an off-duty doctor and a young A & E Support person named Katherine (Kat) from Oxford were carrying out resus under instruction. I slotted myself into the role I knew I’d have and began assisting my colleague. Two crews arrived to help and I asked everyone except the ECA to leave and create a view-blocking screen for us. We worked furiously on the man and one shock was delivered early on – this shock was about to be given as people stood on the metal escalators – a warning had to be shouted for them to get off in case they caught a jolt from it. That button should never be pushed until you are absolutely sure of the risk to others. The five second delay was worth the safety of bystanders.

Kat was wearing marigold gloves and I reasoned that she’d been given these by staff because nothing else was available when she asked for them. It was very strange to see someone compressing a patient’s chest wearing those brightly coloured and overly large mittens. It would have been funny if it wasn’t…if you know what I mean. She worked tirelessly alongside us and defintiely contributed to the outcome.

An output was eventually detected and the patient was taken to hospital, where he survived and was taken to Intensive Care. Unfortunately I learned later in the week that he died three days after we’d ‘saved’ him. Usually the saving part is important so that family members can say goodbye in the small window of time provided by medicine but I also learned that the poor man had no family to say that to him.

Sometimes people need to be taken to hospital because they have issues, rather than physical complaints. A 24 year-old who ‘passed out’ but seemed to be faking it all while her friends and concerned lecturers hung around, bore self-harm scars on her upper arm and wrists, so conclusions, whether right or wrong, were drawn about her sudden, inexplicable collapse prior to an exam.

My epileptic patient was moved by passers-by who’d witnessed him have a fit. He was soaking wet from the rain that had fallen recently and they felt it necessary to take him into a dry building for his own safety as he recovered. I thanked them as they left – it was entirely reasonable and human of them I think. The 30 year-old patient had a cut to his lip and was still post ictal but he was getting better; less vague and irritable. By the time the crew arrived, he had been told what had happened and willingly went to the ambulance for further checks.

Be safe.

Wednesday, 22 October 2008


Day shift: Seven calls; two assisted-only; the rest went by ambulance.

Stats: 1 Head Injury; 2 Chest pain; 1 EP fit; 1 Anaphylaxis; 1 RTC with minor injury; 1 Electric shock.

I was five minutes ahead of the ambulance when I arrived at my first call of the morning, a 55 year-old man who was unconscious in his hostel bedroom. The staff was waiting and the bed had been lifted up against the wall ‘for his own safety’, bizarrely. Maybe they’ve had a rash of incidents in which beds were used as weapons.

The large, naked man was in the recovery position and not quite unconscious because every time I tried to carry out my obs, he’d move and attempt to stand up, only to fall back into a slump again. His breathing was noisy and he was bleeding from a mouth injury, indicative of a seizure, although the staff stated he wasn’t epileptic and they hadn’t seen him fit. Nevertheless, he was an alcoholic, so fitting would have become part of his medical history sooner or later (or now in fact).

He also had a head injury and that concerned me because, fit or not, the cranial defect would contribute to his behaviour and possibly exacerbate his problem. When the crew arrived I was struggling to keep control of him, even with the help of a large member of the hostel staff. Moving him out of the small room in the chair was going to be highly risky and the thought crossed my mind that it might be easier (and safer) to have him put to sleep by a Delta Alpha. It’s been done before and I’m sure it’ll be done again. He was combative and moved spontaneously, so he would unbalance us on the narrow stairs we had to manoeuvre him down. Oh, and when I say put to sleep I don’t been permanently to sleep…

While we mulled over a plan for his removal to hospital he became less irritated and seemed to be recovering a little, so things were going to be easier for us...well, for the crew – they were the ones who would carry him. We used this window of opportunity and got him out of the building. He was still an awkward, dangerous cargo to take down those stairs but my colleagues did a great job and soon enough he was breathing fresh air – as were we all.

Pharmacists, surprisingly, will not always give drugs in an emergency. My next call to a chemist on Oxford Street was for a 61 year-old man with a history of heart bypass who was complaining of chest pain. The pharmacist was with him and she made a couple of comments to me about how long they’d been waiting for an ambulance. ‘Twenty minutes we’ve been here’ she said, repeatedly. I’d only just received this call (and I try not to stop and do a bit of shopping during my emergency calls as I feel this would be unprofessional and make me rush to buy something on impulse without thinking the cost/quality/value principles through), so I explained that I had only taken five minutes to get to her.

I ventured to ask her if she’d given GTN or aspirin (the patient had forgotten to bring his GTN spray) and she told me she hadn’t. There really is no reason for her not to have done so but I know that a lot of pharmacists are not keen to get involved in case they get sued or struck off. Amendments in the law allow for some drugs, including GTN and Aspirin to be given in emergencies, even by a suitably trained member of the public if the patient agrees and needs it in an emergency.

The crew took the man away (I gave the necessary drugs) and the pharmacist went about her business – I don’t think she was impressed with us.

A 21 year-old epileptic man who had a fit at University was recovering when I arrived, so he declined to go to hospital. Fair enough.

My next chest pain call was for a 48 year-old man who was led from the bus by one of the inspectors at the terminus. Chest pain patients shouldn’t be walked at all if possible and I found the fact that I’d been called to attend the man on a bus, only to find him sitting on a park bench, more than a little disturbing. I asked why he’d been moved and the inspector (who is first aid qualified) told me that he thought it would be good for him to ‘get some air’. Who is teaching these people? I’ve even heard of an organisation that is telling qualified first aiders they cannot give an Epipen to an anaphylactic. This is rubbish. Anyone can give an Epipen in an emergency – if you don’t, someone will die. Maybe these instructors should read the HSE guidelines before they train first aiders.

Anyway, this patient had also forgotten his GTN, so he needed to borrow some of mine. Then he was taken away by the crew and I decided to move away from the terminus to do my paperwork. I was facing the wrong way on a bus lane with nowhere to go but forward to the lights – I couldn’t turn around, so I put my lights on and slowly made my way and was immediately obstructed by a bus coming in to the terminus. I hoped he would let me pass but he didn’t. For some reason, he took umbrage to the fact that I was driving the wrong way so he just sat in front of me and forced me to veer around to his right, further obscuring my vision of the road and making things a lot riskier for me and pedestrians. I have no idea why we get such little respect. If I’d been driving a police car I can almost guarantee his attitude would have been different. For a few seconds it looked like a stand-off between two gunfighters – a large red one and a small, yellow (and therefore less appealing to viewers) one.

An Austrian language student (learning English incidentally) ate a peanut and had a massive allergic reaction. The 12 year-old knew she was anaphylactic but didn’t know she’d eaten the nut. She didn’t have her Epipen and so I gave her an injection of adrenaline as soon as I saw her puffed up face, bulging eyes and scared face. Her wheezy breathing was caused by a ‘fat tongue’ and ongoing occlusion of the pharynx – a recipe for death if not dealt with quickly. A speedy decision to administer adrenaline increases the efficacy of the drug in these circumstances.

By the time the crew took her into the ambulance, she was feeling and looking a lot healthier.

The crew and an off-duty police officer were on scene and dealing with a 24 year-old woman who’d been hit by a motorcycle. She had a minor cut to the chin but was a bit shaken up, as you can imagine. I stuck around to se if I could be of any use and found that I couldn’t, so I left them to it.

If you aren’t an electrician, don’t try to mend live electrical fixtures – you are likely to get a shock. Like the 22 year-old smiley-faced amateur electrician who wanted fix the light switch at work. The live wire gave him a jolt and he was left with a flash burn (not a penetrating burn) on his palm. After an hour, he developed a tachycardia and set off to the nearest walk-in centre for advice. We were called and I found him sitting up, happy as Larry (whoever he is), with a healthy ECG and a settling heart rate. I thought a 12 lead wouldn’t go amiss and advised him to go with the crew anyway. I also advised him not to play with stuff he didn’t understand – wise words from someone who used to install electrical sockets and connect them with a live circuit. Wise words from someone who’d had a few shocks himself. Still, isn’t teaching all about learning in the first place?

Be safe.

Monday, 20 October 2008

The Pacifier (for a change)

Night shift: Ten calls; one assisted-only; one no trace and eight by ambulance.

Stats: 1 Faint, ?CVA; 4 eTOH including 1 with a head injury and 1 fitting; 2 Sober head injuries; 1 Assault with fractured cheek; 1 Chest pain.

A 55 year-old poetry publisher collapsed at a posh gathering of writers and associates – he appeared to have fainted and was recovering but his answers to simple questions like ‘what’s your name’ were slow and vague, so he was taken to hospital on the assumption that something else – something neurological – may be going on. Meanwhile, I went around the block twice trying to get out of the little square that I had become locked into. London is full of these quaint, traffic-unfriendly and annoying places.

My hand was gripped and warmly shaken by a 50 year-old drunken man whose two large sons had called us because their father was becoming difficult to handle at a train station. He smiled at me, shook my hand and then told the crew to ‘f**k off’ before the smile had left his face. Neat trick. Only playing the part of an evil Emperor or vast amounts of consumed alcohol can make that performance look easy.

Alcohol also makes people cry far too much when a few tears would normally suffice. In fact, crying for no reason at all is oft times part of the effect, as was the case on my next call to a 25 year-old female who’d had a little too much. She too had settled down at a station – underground this time – and she too became a completely different person when the crew took over from me. The thin, dreadlocked woman was taken away, weeping and moaning about stuff, only to turn around and start abusing the crew as soon as I had gone, according to the accounts I heard later. She was thrown out of hospital by security apparently. I never knew I had such a calming affect on emotional drunks. Usually I’m the one getting abused. Tonight made a nice change.

The serious call of the shift was for a 25 year-old male who was found in the middle of a very busy public place with a massive head injury - apparently he fell…allegedly.

HEMS was called for this one and there was a crew and another FRU on scene when I arrived. He was conscious but not in good shape. When HEMS pulled up in their distinctive Subaru, the team went with him into the back of the ambulance and I knew that they would probably RSI him for his own good (you can look up these abbreviations in the TPD glossary. Although by the time I’d typed that in I could just have told you what they meant. Never mind…too late).

A call from a phone box for an alleged fitting person turned out to be the invisible man having a seizure again, so I called that one a no-trace. Soon afterwards I was in a hostel holding down an alcoholic who was having his fourth seizure of the night in quick succession. I had to be very careful to avoid his size ten boots as they flailed around on his feet, looking for a yellow-jacket wearing target. Luckily, his aim was poor.

A 22 year-old whose girlfriend described his assault as a ‘pummelling’ stood inside a noisy club in the early hours nursing a broken cheekbone after someone laid into him for whatever reason is needed these days. He seemed like a sensible, fairly sober type of guy but I think he needs to have a word with his partner about her choice of words while he’s feeling sorry for himself. Outside in the drunk world, a large lorry is continually hooting his horn in anger at the empty ambulance (the crew are with me) on the road. They have parked rather inconsiderately and he’s not happy. How dare an emergency service vehicle park so that a large, smelly vehicle cannot pass! The ambulance driver should at least have spent time looking for a perfectly shaped area between vehicles before jumping out with his crew mate to deal with the call. I mean, someone could be held up for ten minutes by such antics. Hey, I’m being ironic and sarcastic incidentally. He wouldn't have been making that racket if it had been a police vehicle on duty.

Then I spent a long time looking after a 19 year-old drunken man who was lolling and vomiting on Leicester Square while his diminutive Chinese ‘friend’ kicked him in the back of the knees if he dared to stand up and stagger, ensuring that his legs buckled and he came crashing back down again – control restored. I had to warn the guy to stop doing it. His drunken mate already had a small head injury as a result of falling and the technique currently being employed to keep him in the same place until a taxi was hailed, wasn’t working to his benefit. I certainly couldn’t stand by and watch as he was repeatedly assaulted in the name of friendship.

I intended to sit and monitor him until he was scraped off the pavement and into a cab but as the hour wore on I realised he was going nowhere and was only fit for hospital, so I requested an ambulance for him and sat in the car, or hovered around him, keeping an eye out for any sudden deterioration. All he needed was a bed and a chance to sober up but he was too out of it to go home, especially with friends like the one who was coaching his knees to crumple.

I apologised to the crew when they arrived and the little Chinese guy, who refused to travel with his mate, mocked a phone at his ear and said ‘call me’ to his drunken companion. I thought they might be lovers the way he’d said it, then I thought the patient would never remember the emotion of it anyway.

Later on, when I’d recovered from my long stint of being a knight in green armour, I went off to a Red1 in Soho, expecting to find a corpse or as near-as-dammit lying in the street. Instead I found a crowd gathered around a young woman who’d slipped while running. She’d been unfortunate enough to run into a pool of cooking oil that had been left in the middle of the pavement by someone.

Police were on scene and blue chequered tape was being cordoned around us to stop people from walking into the same disaster area. The tape was tied around the wing mirror of my car for want of a better place. I felt offended... a bit.

The 25 year-old was flat on her back and absolutely covered in greasy, slimy oil. Her hair was ruined. She complained of pain but wasn’t specific – I think the shock of ice-rinking it along the pavement when she didn’t expect to and then landing unceremoniously on her rear didn’t do her confidence any good. She was sobbing.

She was still sobbing when she walked/slid to the ambulance.

My shift ended in the wee small hours with a 40 year-old man who just wanted to get off the cold streets for the night. He told the police he had heart problems. They didn’t believe him but we are not here to judge, so he was taken to a warm, safe hospital with all the others who’d gone before him.

Be safe.

Sunday, 19 October 2008


Night shift: Nine calls; one declined; one assisted-only; the rest went by ambulance.

Stats: 1 Assault with head injury; 1 ?Fit; 1 Unwell baby; 2 eTOH; 1 eTOH with Head injury; 1 eTOH with Facial injury; 1 DIB.

I took my first call without knowing what I was going to. This happens when a call is still in progress and FRED gets a bit over-eager to stop the clock. We get despatched with the address only and we are expected to run until further details are available. Unfortunately, on a number of occasions, I’ve arrived on scene before being updated with said details, so getting outside a dodgy housing estate and then seeing the words ‘do not enter premises – murderer inside’ can be the closest of calls. Okay, I’m only kidding about the example – there was no murderer and I’m sure my colleagues in the bunker would call me and give me the heads up, wouldn’t they? Still, my point is made.

So, I arrive and it’s an assault – a 40 year-old man has been hit over the head with a bottle. He’s very agitated, as you’d expect from a decent head injury but his shoulder is injured too and he complains loudly when it’s touched...or even looked at. The crew take him away, gingerly persuading him to do the walking because he won’t allow any sort of assistance.

Another call for a warm bed I think on the next job. A 35 year-old man claimed to have had two fits outside a bus station but he’s not epileptic and shows no sign whatsoever of having had a very recent seizure.

‘Did anyone witness your fit?’ I asked.

‘Yes, my friend did.’

‘And where’s your friend.’

‘He got on the train and went home. He said he’d send some money through the bank for me tomorrow, ‘cos I’ve got nothing.’

So, not a very close friend then, I thought.

The man was clearly on the street and needed a place to lay his head. It’s cold tonight and I don’t blame him. I just wish he’d be truthful with me.

On to a premature baby that’s being fed via a gastric tube and has been vomiting. Mum is worried and there’s a crew on scene when I arrive. I hear the story of this little mite’s problem birth and the host of medical issues that are currently cramping her life and I feel like crying. I do the BM and her little foot keeps bleeding, regardless of the pressure I put on it. I feel guilty about this and eventually, after five minutes of pressing and re-pressing, she stops leaking. Now I can go without feeling that I’ve added to her misery.

A 61 year-old woman who was ‘shaking badly’ had nothing wrong with her and her family gathered around the bed as she jerked about for no reason. It cost an ambulance before she declined any aid because she’d been exposed. I will never understand why people do this to us.

If you call us don’t expect to be taken to the hospital of your choice. Like the 54 year-old alcoholic who’d had a ‘disagreement’ at the local hospital and now wanted to be taken to another one, miles away. He complained of vomiting blood but there was no evidence of this and he’d been waiting in a callbox for me to arrive. I left him and his insistence with the crew. I'd been a target for the local louts in this estate before and I thought better of sitting around while they armed themselves again.

Another drunken person, a 22 year-old woman, fell off her bike and ended up being collared and boarded by us when we arrived. She had fallen hard enough to do damage to herself – now she had neck pain. She was also drunkenly agitated, which makes things a lot worse to manage.

Still on the drunken scene, a 68 year-old man was found collapsed after falling and hitting his head on a wall by passers-by, one of whom was a ‘qualified first aider’ and who insisted that he had ‘a right to be there’ even though I hadn’t actually spoken to him - nor had I challenged his rights to do anything. The man on the ground was very, very drunk and was miles from home but he refused to go to hospital and gave the crew a hard time. He stormed off and became my next call when he was found lying in the middle of a busy road with fresh injuries to his face, after repeating his previous performance. This time, however, he was lucky not to be killed.

Again, I got abuse from a person in the know, when I proceeded to get the patient off the road and into the ambulance without collaring him. I knew he’d just fallen because I was told he’d just fallen – he hadn’t been hit by a car and hadn’t crashed down from a height but that didn’t stop another bystander from shouting at me and describing to all and sundry how I was doing it all wrong. They'd never do it that way on the telly.

Next time, I’ll wait in the middle of the road, struggling with a drunken, combative patient as I put a collar on for no reason and get me and the patient killed by a passing car/truck/bus/bicycle. That’ll teach them!

In the early hours I was called to an emphysema patient who had DIB. He was standing outside his flat, leaning against the railings. He’d been asked politely not to move but he’d insisted. I had to shoo him back inside and carry out my obs while he recovered from the distress of moving when he had very little oxygen to keep him going. His flat smelled strongly of fresh paint but he denied he was doing any decorating – the doors were off their hinges and the place had paint lying around (big clue). Fresh paint fumes are never good for those of a clinically fragile pulmonary disposition. His sats were dreadful but as soon as he went back on his home O2, they improved. The crew took him away to hospital and out of the danger zone. He was, all in all, a thoroughly nice chap.

Be safe.

Friday, 17 October 2008

Stone cold

Day shift: Six calls; one false alarm, one hoax, one treated on scene, one cancelled (I got lost) and two by ambulance.

Stats: 1 Hypothermia; 1 Faint, 1 Hypoglycaemia.

Being a professional alcoholic and spirit-gel stealer/drinker means that, as an occupational hazard, your body won’t survive normally survivable things…like cold weather. My first patient, a 30 year-old man, was discovered lying on the freezing ground in a small garden by Lambeth Palace. If he’d been sober, he’d have had the sense to move somewhere warm, or cover himself up but he didn’t. He probably thought the mixture of Lucozade and alcohol-gel would suffice for insulation.

A passer-by on his way to work had the good heart to stop and ask if he was alright. On getting no response and feeling how cold the man’s skin was, he decided to dial 999. This action probably (more than likely) saved the alcoholic’s life. When I arrived he was so cold that his joints were bent inward because the ligaments had contracted and he was barely conscious. His temperature read 32 Celsius - he was definitely hypothermic and as soon as the ambulance arrived, which seemed a while, he was taken straight into the warm and then rapidly to hospital.

I would have given him no more than another hour or two out there before he died. That little park is in the area of nobody’s business at that time in the morning, so he was very lucky to have been found and even luckier to have been approached.

Lambeth Palace has several CCTV systems and one of the cameras spotted me outside the premises while I did my paperwork. I was also admiring the brickwork of the building and thinking about the men who laid them. The entrance door is tiny and people of that time were generally smaller, so my mind could imagine dozens of five-footers working up on wooden scaffolding during the construction of this magnificent building. Anyway, one of the guardians of the palace came out to check if everything was ok and I told him I was just doing my paperwork – that reassured him and he went back inside. Only then did I wonder why there was no camera covering the park, which is directly inside the grounds.

I spent twenty minutes trying to locate a man who’d been hit by a fork lift truck. I was in an area that was unfamiliar to me and a railway line stood between me and wherever I was supposed to be, according to my mapping system. Despite further information from Control about where I was (which I already knew) and a fruitless scoot around, I was cancelled when a crew arrived at the correct location – a local crew with better knowledge of the area I presumed.

A suspect vehicle near Buckingham Palace sparked a security alert and a cordon was set up with me and a MRU inside it, just in case. After waiting with my colleague, the police and fire crews long enough for a few hundred tourists to gather and start asking the same questions over and over again, I was cleared to go. The dodgy car was safe apparently; just badly parked. I bet a lot of our visiting guests think we are a bit over the top here in the UK when it comes to illegal parking. Where they come from a ticket would usually suffice.

A new face to the street-sleeping scene next and I felt sorry for her to be honest. She admitted to drinking a lot recently but that she wasn’t an alcoholic. She hadn’t eaten for three days and now she felt ill and cold. I found her trying to keep warm under her thin jacket on the Strand. A rough-sleeping friend was helping her but he was also trying to flog copies of The Big Issue so that he could eat too. Busy commuters have little time to buy magazines for the sake of it, so he stood for a long time as I tended to his acquaintance.

She told me she’d been on the streets for years but had just arrived in London (yes, even rough-sleepers migrate) from the coast. She was genuine and obviously unwell, so a trip to hospital was on the cards, along with a meal if possible.

For the record, I help where I can by giving whenever I can. I have a healthy respect for most rough-sleepers; they’re not all drug addicts and drinkers. I was one myself for a short time.

My stand-by on Trafalgar Square was spent chatting with a FRU/flight paramedic from Sussex. We talked about the job, the wages, the problems and the politics. We agreed that everything was pretty much the same but that he had the seaside. We have seagulls here but they are scavenging idiots and have no idea where the sea is. They think they are pigeons ‘til they speak.

My no trace hoax call was a Red1 for a ‘male lying on the ground’ which doesn’t say a hell of a lot about anything. It was hardly likely anyway because the street he was supposed to be lying in was packed with people and none of them was panicking, waving, staring or referring to anything vaguely ‘dead’. In fact, my intrusion with yellow car, blue lights and loud siren made most of them plug their ears, shoot me looks and scurry away for fear that I might be coming to take them away. The call description contained the line ‘caller hung up’. Well, of course he did.

Green Park underground station has one of the longest walks I’ve experienced at a station, from one area to the other. As usual my patient, a 25 year-old female who was ‘hypo’, was at the far end of the complex and me and my heavy bags were much fitter and slimmer by the time we reached her. She was an anorexic Polish girl with a recovering BM after her near-collapse. She had a bar of chocolate now, courtesy of the underground people (the moles) and she had no interest in me, my bags or the safety of a London hospital. In return I had no real interest in struggling the quarter mile, or whatever it was, through corridors, steps, multiple flights and bustling, jostling people while I carried her.

When the crew arrived I explained that the lady had gone and was fully recovered. They too had realised the ordeal we’d have if she’d needed carrying. We agreed between us (not that I’d ever work with this crew at the same location again) that the best way to move a patient in this complex was by train. If we had someone really ill, or being resuscitated, we’d commandeer a train, load the patient onto it and scoot down the line to the next platform, where unloading would be much easier. It was initially a bit of a joke but the more I thought of it the more I realised it was a sound idea. In fact, I wouldn’t be surprised to learn that someone else had already done it in the past. If not, then I claim sole rights to it (ok, me and the crew).

For the many people who emailed and commented about the kitten in my last post - HIS name is BEAR and he belongs to two very good friends and colleagues of mine. I might start a special 'cat's corner' section for you lot!

Be safe.

Wednesday, 8 October 2008

Climate change

HEMS has a new recruit!

Day shift: Six calls; all by ambulance.

Stats: 1 Stabbing; 1 unresponsive person; 1 Broken hip; 1 Cardiac arrest; 1 anaphylactic reaction; 1 Non-cardiac chest pain.

The weather is turning cold now and the week has been busy with ‘proper’ calls – the kind of jobs you get when the winter depression sets in.

Police arrived after the ambulance and me to a 21 year-old man who’d been stabbed in the hand during a robbery at his hostel. The injury wasn’t serious but the assault was and the cops started looking for the assailant as soon as they had a description. It was very early in the morning and I wondered at the mentality of someone who goes around stealing people’s stuff then stabbing them before breakfast.

Lying on the ground in a park was a 30 year-old man who’d been found by the police. The crew was on scene just ahead of me and the man on the ground was conscious, although he couldn’t or wouldn’t open his eyes. It was clear he was keeping them shut deliberately – you can tell by the way the eyelids tense. Nobody knew how long he’d been there or what his problem was but we managed to establish that he was Romanian and probably homeless. He may have been using the system to get a warm bed for the day. To be honest, moan as I do about the abuse of our ‘sponger-friendly’ system, I can’t blame someone for trying to get out of this freezing weather.

I was asked to support a crew on scene with a 92 year-old woman who’d fallen at home and broken her hip. The attendant is a paramedic but is not yet registered, so can’t give drugs or perform invasive procedures without supervision, so I took myself up to the estate where they were and simply showed my face so that the paramedic could get on with her job. It can take weeks or even months for a newly qualified paramedic to get registered and during that time they cannot practice, even though they are perfectly capable.

I had just been cancelled on a Red1, ‘Cardiac arrest’ call because a nearer vehicle had become available when I received a Red2, ‘ineffective breathing’. These calls usually convert to Red1 cardiac arrest and this one followed that pattern a few seconds before I arrived on scene. The ambulance was pulling up with me but the crew hadn’t received the update, so I let them know that it was now a suspended.

Upstairs in the building, a 66 year-old man lay on his back where he’d fallen six or seven minutes earlier after struggling to breathe. Nobody had carried out CPR but there were at least half a dozen people around in the room, which was some kind of office.

I worked with this crew on the hotel cardiac arrest – the one we saved – and I have worked with one of the crew on at least three of these in the past, so we knew the routine and settled into it very quickly. Shocks were delivered, drugs were given and his airway was sorted out when it became difficult to manage, although nowadays my brief is to concentrate on the defib, drugs and fluids. The airway is not as important as it used to be.

A second crew was requested early on but nobody appeared until we were preparing to move the man and he was strapped into the chair. A hysterical relative suddenly appeared and had to be gently moved away and no matter how many times the people around us were told to leave the room, they persisted and hung around the doorway, causing obstruction for us when we wanted to get the patient out quickly.

The second crew helped us to get the man down to the ambulance and we continued CPR all the way to hospital, at one point with me on the floor after I’d been thrown there by the movement of the vehicle.

The patient arrived at hospital in the same condition in which we’d found him and after a few more minutes of CPR, the doctors called it.

If you come across a cardiac arrest and you have any idea about CPR (you don’t have to be trained formally) – please try. If you leave someone lying on the ground for six minutes before anything is done, then don’t expect a survivor. Any CPR is better than none and mouth-to-mouth isn’t necessarily that important (recent research has shown), so start pumping the chest until we get there. I would never forgive you if you let my mother lie there without help for so long.

A car pulled into the pavement just outside the Houses of Parliament and the security people got nervous. Inside was a 51 year-old cancer patient who was having a severe allergic reaction to something she’d eaten. She had a history of anaphylaxis and now she was scratching so much that her arms and neck were grazed and gouged. Her throat was closing and she was panicking when I got to her.

I started her on a nebuliser and was about to give her an injection of adrenaline when the ambulance pulled up alongside. The drug was given a few minutes later when she’d been moved to the trolley bed. Then off she went on blue lights to hospital.

I ended my shift at a restaurant in Leicester Square, where a 25 year-old member of staff was complaining of chest pain. A couple of questions about the nature of the pain and a few basic checks convinced me that the discomfort was probably not cardiac-related. His age and demeanour helped confirm that but once the crew was on scene an ECG was carried out, just in case.

This job was behind my usual stand-by location in this area. I only had to move the car from one corner to another – another ORCON buster. I expect my medal’s in the post.

Be safe.

Sunday, 5 October 2008

The glass woman

Day shift: Nine calls; one treated on scene; one arrested; one declined aid and the rest by ambulance.

Stats: 1 EP fit; 2 Falls - one with facial injuries, the other with multiple fractures; 1 Human collision with minor injuries; 1 Drug o/d; 1 Chest pain; 2 RTCs - one with minor injuries, one with no injuries; 1 Self-harmer with cuts.

A busy day then.

Morning rush hour and the cafes are full of people buying their first cup of over-priced coffee and perhaps a muffin. In one of these places a 30 year-old woman has had a fit and is now lying on the floor with a FRU colleague in attendance. I’ve been called because a ‘Hotel’ (our term for a paramedic) must also be on scene when someone has or is having a seizure, in case drugs are required. The lady was post ictal but recovering and I did nothing but watch and wait for the ambulance.

Then onto the cold streets for a 75 year-old woman who stumbled down a step and landed on her face, knocking two of her front teeth clean out and damaging her nose and mouth. A first aider had stopped to help and when I arrived, her ungloved hand was holding a dressing under the poor unfortunate lady’s nose as it dripped fresh blood.

I had a look at her injuries and checked that she hadn’t hit her head and that she didn’t have any medical conditions that could have either contributed to or been exacerbated by the fall. Her friends were milling around her and I think they had plans to enjoy the day in London (they were all from up north).

Once the bleeding had been controlled, I asked to see the lady’s teeth. They were long and intact. I wondered how such long teeth could come out of such a small person’s gum but I guess at that age nothing holds firm. I asked the first aider, who was keen to help, to get some milk and she went to the trouble of buying some from the local Tesco, which was nice. I transferred a little milk into an empty water bottle and plopped the fangs into it. Hopefully they will remain in good condition and a dentist may, or may not, be able to put them back into their sockets. In the meantime an ambulance arrived to take the lady to hospital.

‘You need to get your injuries checked out at hospital’, I said.

‘Oh, no thank you’, she replied.

There are people who would rather not ‘bother’ the NHS and there are those who, with no reason to, continually harass it. She didn’t want to make a fuss but off she went, after a little persuasion.

Two 6 year-old boys ran into each other at school and the crew and I decided they would live. One had a cut lip and the other had a tiny cut to his head, so I left the crew to it and made my way back to my own area after the long trek south. I teach first aid in a lot of schools each year and the staff are becoming less able to cope with the most minor incidents because they are worried about parents suing them or something. I advocate calling ambulances only where life, limb or skin is at risk, where there is great pain or doubt about a medical condition. Otherwise, if a child bumps his head or cuts his lip, deal with it. A 75 year-old with chest pain needs an ambulance more than a 7 year-old with a bruised leg.

I wasn’t required for the 30 year-old methadone user who’d overdosed. A crew and a MRU were already on scene.

As I travelled back I saw a couple having an argument in sign language. It was heated but you could only tell that from a certain angle. Strange and interesting at the same time.

I had to compete for road space with an Armed Response Unit on the way to the next call for a 40 year-old man with chest pain. Of course, the cops won and I found myself ten seconds behind the ambulance, so I wasn’t required. Cops with guns always win.

‘I thought I was going to go under’, said the cyclist who’d just been knocked off his bike by a bus. He was shaken but, apart from minor cuts and bruises, unhurt. The whole thing was witnessed by a loud and vociferous woman on the pavement. She insisted on relating the whole tragic tale of how the bus driver was entirely to blame and how he didn’t even look before cutting in on the poor unfortunate two-wheeled man. ‘Don’t listen to her, she’s drunk and she’s mad’, the bus driver told me. I didn’t know if he knew her personally or this was his bizarre way of getting out of trouble. Perhaps the International Bus Driver's Manual states that, 'should a person accuse you of bad driving, they are probably drunk, mad or both because there is no way that you can be to blame'.

However, that particluar road, on a very busy intersection, is notorious for cyclists who speed through the red lights, crossing moving traffic. Even as I stood there, with the bendy bus practically parked in the middle of the road and my vehicle positioned so that a block was created, cyclists and moped riders were attempting to scoot through the small gap left between our vehicles and the barrier. It was ludicrous.

Last week at this very same junction a cyclist was crushed to death under the wheels of a lorry. There are still signs up in the area notifying everyone of the ‘fatal collision’ that took place. I was working in the control room when I saw the call come in; ‘person lying on the ground. CCTV confirms he is not moving’. Multiple calls came in for it and one person, cycling to work, never made it.

Clearly, the danger for cyclists is extreme enough without some of them increasing the risk by riding around like lunatics.

My next call cost me an hour but it was needed. An 83 year-old lady had fallen on an underground train and she’d broken her leg apparently. A medical student was taking care of her when I arrived and the train had been kept waiting, full of passengers, on the platform until I got there.

The lady was in pain and, after clearing the carriage of people, I examined her leg, which was being kept still by another passenger who’d volunteered to help. The entire limb wobbled like jelly below the knee and it was clear she had broken both Tibia and Fibula at the joint. She also complained about arm pain and I found a fracture at the distal end of her Humerus too.

The train had pulled away from the platform, a movement that usually starts with a sharp jerk and the lady had lost her balance and gone over onto her left side, landing hard on the floor. She fractured like she was made of glass and only one disease fitted the bill for this scenario; osteoporosis. I managed to get her friend, who was travelling with her, to confirm that she had ‘brittle bones’ as the crew arrived, along with the British Transport Police and more tube staff.

As the crew helped with pain relief and splinting, I asked to have the next carriage cleared because people were still peering in at the poor woman as she lay on the floor. I had cut through her tights in order to examine her leg and her dignity was already at risk. The police completely cleared the train however and as we developed a plan for her removal (no escalators or lifts at this station), the entire station was shut down, causing chaos I would imagine, with mid-afternoon travellers.

Once the lady’s pain had been controlled and her leg and arm splinted, we carefully moved her onto the chair (her leg was supported by a police officer) and we carried her all the way to street level using the stairs. It was an awkward and clumsy lift but we reached the outside world and were greeted by the sight of dozens of people standing patiently behind the entrance barriers. I understand the frustration that many of them felt – we had probably upset a lot of timetables but I heard no complaints and saw no aggrieved faces. If you were one of the people waiting for us to take this lady out of the train, thank you for your tolerance. Thanks to the police officers who helped. All in all it was a good team effort and made my day worthwhile.

The lady’s injuries were confirmed later on.

An assault turned out to be a case of self-harm. A drunken 25 year-old man was seen staggering around Victoria with blood dripping from his hands, so I was sent to check it out and cautioned to wait for the arrival of the police. The area around Scotland Yard is very sensitive and its not hard to find a gun-toting cop, so I wasn’t surprised when more than a handful of uniforms appeared for this one man. He was surrounded by at least eight officers and had two restraining him in cuffs because he was more than a bit feisty. His hands had been cut open by a ragged, sharp lager can that he’d ripped open. He had walked along the street carving it into his mittens until they bled from lacerations on the fingers and palms.

A police officer had already bound one hand up and I looked at the wounds, determining that they weren’t serious. The crew was on scene with me and the attendant decided the injuries weren’t worth taking to hospital – the police had arrested the man and were happy to continue his journey to jail instead of hospital.

At a junction in Knightsbridge, a van flashed a motorcycle and vice versa. The confusion caused by both signals meant that each driver, thinking he was being given right of way, moved at the same time, colliding at the centre of the road. The biker was dragged underneath the van and the front wheel of his machine was crushed and bent by the force. He, however, survived and when I got on scene he was standing on the pavement, mobile phone in hand. He’d refused the help of the FRU pilot who had arrived before me and there were no other casualties.

I helped a police officer to move the motorcycle off the road but because its wheel was bent, the heavy vehicle was difficult to manoeuvre, so my FRU colleague helped. He forced the handle bar on one side down in order to straighten the wheel but this meant that the bar I had my hand on was forced up and into the broken visor section, crushing my hand and cutting it open. I had to yell twice before he realised what he was doing. It hurt, I can tell you. Thus, I finished my shift and went home injured in the line of duty. Not that this washed with my DSO when I jokingly tried to use it as an excuse to stop early.

Be safe.

Saturday, 4 October 2008

Dead in the shed

Day shift: Five calls; one taken by car; one dead at scene; three by ambulance.

Stats: 1 Faint; 1 ?EP fit; 1 eTOH fit; 1 ?Cardiac problems; 1 ?Suspicious death.

It’s getting darker and colder – winter is approaching and within a few months that means the season of goodwill and joy to all men (and women) will be upon us. Oh, wait, I mean the season of drunken debauchery and copious public vomiting. Yeah, that sounds more like it. I'd like to think the new TV campaign 'why end your night like this?' will have an impact and reduce the number of stupid people but I doubt it, especially after being called the 'booze taxi' by a passing Hen group in Leicester Square, one of whom went on to say 'I'll be seeing you later'.

Until then, I am working my way through the shifts with the usual routine alongside my brave and noble comrades.

A 31 year-old Norwegian man fainted twice at an underground station and he was recovering well when I got to him, although I advised him to go to hospital, or at least have an ECG done. He seemed keen to get on with his day and his colleagues stood around outside the station’s medical room waiting for word that he was okay to continue with them. BUT, two faints in a short period where no previous medical history exists can be ominous and so the crew took him to the ambulance and I left them to persuade him not to work today but to get his health checked.

Lying on the floor of her office was a 24 year-old American woman who’d had a fit, although nobody had actually witnessed it. She’d been found collapsed and confused and the assumption had been made. It turns out she has fitted once before but it had never been diagnosed, or at least she wasn’t sure if it was or not. She did have medicine for it but she couldn’t recall what it was or precisely why she took it. She was definitely confused.

It took more than 30 minutes before she made sense again and the same amount of time waiting for an ambulance before I decided that, clinically, she was fit enough to travel in the car.

My next fitting patient was lying on the rain-soaked pavement of a busy street and I took a short handover from an umbrella-bearing man who’d stopped to help him when he’d seen him suddenly fall down and have a seizure. I asked the man with the umbrella his name and thanked him for his help, while I covered my patient in a blanket and did my best to keep him (and myself) warm and dry. People rushed by with vaguely interested faces on them and I had neutral emotions about London for a time. If it hadn’t been for the umbrella man (and one other who’d left when I got on scene) this poor fitting person may well have been left to it on his own.

Umbrella man took his leave as soon as I was into my obs and once again I thanked him for his kindness. Then I spent fifteen minutes or so on my own crouching over the semi-conscious patient as he began to slowly recover on oxygen. Legs and feet passed within inches of us but they were all in a hurry to get somewhere. The people at the top of them were only marginally curious and the more hardened commuters defied their instincts and ignored the obstruction altogether.

Once the patient was able to speak, I asked his name and he gave me the same name that umbrella man had given – how unusual, I thought. The ambulance noisily pushed its way through the rush hour traffic and arrived just in time for my interest in the name coincidence to evaporate. A bed was brought over and the patient was loaded on board.

He was an alcoholic, we learned and he hadn’t been drinking for a while, so his fit was probably the result of withdrawal. At least he was out of the cold, rainy morning...as was I.

Another person who fainted twice in a short period of time was a 71 year-old Indian lady, whose daughter was very concerned about why this was happening. I would have reached them both quicker if the staff at the shop (I wish I could name it) had bothered to meet me and guide me to them but they were all too busy selling stuff to customers and I entered completely unnoticed by some and ignored by others. I had to approach one of the counters and ask where the patient was. I got a shrug of the shoulders and a blank, disinterested look. Only then did the woman’s daughter come up to me herself and show me where her mother sat.

The lady had fallen ‘like a stone’ according to her daughter. Once after walking around and again when she got off the bus. She had hurt her knees as a result but I was more concerned with why she was passing out.

A stoical woman, she showed little interest in going to hospital and I had to persuade her, with the help of the crew, after her ECG had been done. It looked like she may have a heart block, a cardiac condition that would result in faints. She took our advice and I left the scene knowing that if I was wrong at least she’d be properly checked out.

A Red1 for an ‘unconscious’ man, ‘not moving’ became a cardiac arrest with ‘caller declined to start CPR’ and I was on my way to a possible suspicious death. We are not officially allowed to state that something is suspicious but we can determine whether a death merits investigation or not.

The man had been found by his neighbour. He was on his knees and bent forward in the corner of a little brick shed in his garden. He had been preparing to paint it but not a drop of the stuff in the tin was touched. The ambulance crew had arrived on scene with me and as we approached from behind, we could tell he was dead.

He had a head injury and there was a good sized pool of blood on the floor where his head was resting. We had to move him in order to establish that he was beyond help, so we pulled his body over on to its back and during this process we saw enough evidence to support an evaluation of death - Post Mortem staining all over his trunk and head. Asystole was established over two minutes and I recorded a time, pronouncing him life extinct.

The police were called, as is normal under such circumstances but closer inspection of the head injury gave me cause for concern. I can’t describe the wounds in detail but I will say that I wasn’t sure if they were consistent with a fall post cardiac arrest. The police agreed and CID was brought in to investigate. It would be up to them and the Coroner to decide whether he’d died naturally or not.

Be safe.

Friday, 3 October 2008


Day shift: Five calls; one taken by car; four by ambulance.

Stats: 1 Mental health issues/drugs; 1EP fit; 1 Abdo pain; 1 Haematuria; 1 eTOH.

It’s 6.30am and there’s a half-naked woman running around outside a club. The police are on scene and I’ve been called because they think she has mental health issues. She has come out of the nightclub, pulled her trousers down, removed them completely and left herself exposed in a T-shirt and knickers for the world (and their door staff) to see. Clearly she has issues of some kind.

She may have taken drugs and she is clearly unstable because she fights the police when they try to move her to the ambulance. I requested a female crew (or at least one female on board) because this would be a tricky one for an all-male crew. She won’t allow us to cover her up and keeps ripping the blanket away.

I leave the crew to sort it out and a police woman stays on the ambulance with them for extra security because she is behaving very strangely and nobody knows what she’s capable of doing. For this reason, she’s handcuffed.

A 29 year-old woman had an epileptic fit at a hostel but she was recovering when I arrived and a crew was with her, so I wasn’t required.

Abdo pain next and a 29 year-old shoe-shop worker was lying on the bench in the middle of her store (now closed due to ill person inside) when I arrived on scene. After a short chat and some basic obs I persuaded her to sit up. I don’t like it when patients loll around while I’m trying to help them – I don’t mind if they are really ill but this young lady, with her reported pain score of 9/10, was still capable of smiling and talking without dropping a word when she referred to her male colleague in the shop.

I gave her entonox and decided to take her to hospital myself, rather than wait the twenty minutes or so that I would have to endure because there were no ambulances available. There was no vomiting, no fainting, no medical history and no reason for me to waste a resource when I could pack her off myself, so I did.

She managed two phone calls on her mobile during the trip and only used the entonox for her pain when I reminded her that it was there if she needed it.

One of our frequent flyers, let’s call him ‘M’ generated a 999 call from an Ann Summers shop in Soho. He was lying face down on the carpet, just inside the doorway and strangely, there were no customers. He was drunk, smelly from the streets and was now urinating frank blood, which is why he requested the ambulance by being dramatic and falling into the shop. This is what he does and he has been doing it for years. The only time he isn’t abusing us is when he’s in prison…for abusing us.

I picked him up and persuaded him to get out of the store. He demonstrated how genuine his condition was by putting his hand down into his trousers and producing two bloodied fingers – ‘See, I told you I was pissing blood!’

Although it’s always nice to have evidence and to be sure of a diagnosis, I wasn’t really impressed with him, so I sat him in a corner and called Control so that the ambulance could be hurried up. Unfortunately, we were fresh out of ambulances at that particular time and I knew this guy so well that I put in a request for special treatment because he was liable to become aggressive and violent if he waited too long. He has attacked me in the past and it would suit him to be back inside, so an assault on me would buy him some time in the warm as winter approaches.

Control sent me a CRU as back-up but this just made things worse because M hates this particular CRU colleague, so he shouted, pointed and generally made it clear that he wasn’t happy to see him. Now I had an irate, drunken and potentially violent man stomping around the area. I had asked the cops, who’d turned up to see if I needed help, to leave me to it, on the basis that if I kept it nice and one-to-one, M would be quiet and compliant but now I needed them because his behaviour deteriorated as time went on.

An ambulance was despatched after twenty minutes or so and I asked a police officer to come and stand over him as he ranted and swore and thumped public property in an effort to show us how much he hated peeing blood. At one point he stood shouting his pain at me whilst drinking a lager that someone had donated in order to shut him up. Then he lit a cigarette and puffed at that until he collapsed again.

‘Why is it doing this to me?’ he wailed as he looked at his pint. I prayed that he’d answer the question himself and see the error of his ways but I may as well hope to win the lottery twice in a row.

My adventure with him ended when the crew turned up and he became a lamb. The appearance of transport to a free bed and perhaps an overnight stay has that effect on him. My years of dealing with him have taught me never to trust that quiet side of him because if I do, I will end up getting hurt (and I don’t mean my feelings).

Just to help me on my way home, the last call was to another drunken man. This one was slumped outside a Pizza Hut and they simply wanted shot of him because there were paying customers inside, eating their dinners. Fair enough; I wouldn’t want to be eating an over-priced pizza meal in plain view of an alcoholic who’d urinated all over the pavement and wasn’t even good humoured.

The crew was on scene when I arrived, so I assisted them in getting him on board the good ship NHS ambulance for his ride to a better place (where the food is free). As his obs were being done he helped us out enormously by passing the foulest and most persistent gas I’ve experienced in a long time. The vapour was actually sticky and couldn’t be removed from my uniform for hours afterwards. Not only did he offend us once to the point where the ambulance doors had to be flung open, he decided to repeat the performance again and again. This man had a real problem keeping it to himself. Jobs like this make me so glad I’m on the car; I can get away from it, the poor attendant had to stay in the back with him all the way to hospital. He will no doubt have been put off eggs for life.

Be safe.