Friday, 3 October 2008

Foul

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.

5 comments:

Anonymous said...

Eugh! I can almost smell the last job (and I did dry heave at the description!) as I type this - I hope the poor attendant had a gas mask!

Could you explain what frank blood is? I thought at first it was something bad like an arterial bleed but obviously it wasn't?

Thanks,

Jay

Louise said...

We had a similar patient this week, My colleague was tall enough to have his head poking up into the open sky light, I was driving with all the windows open and my head hanging out!!

thegreenghost said...

Jay - Passing frank blood means the patient is peeing fresh blood only (ie red with no/little urine), which probably originated in the urethra (or some place else after the bladder in the urinary system, or at the sphincter itself).

As opposed to brown/black/dark red lumps of blood (clots), which would have originated further up the system eg in the kidneys. Or passing intermittant bits of fresh blood in the urine (which can look like really watery blood or be urine with streaks of red in the stream) which could be from a light bleed in the bladder.

Hope that helps,
Ghostie

Anonymous said...

Hi Ghostie,

Thanks for the reply - that's great!

Jay

Kieran said...

Hey Xf, long time no read. Just in college at the moment doing some assignments, had a look at universities and it looks like i may be able to get into sheffield to study paramedic science! Trying to get work experience with paramedics is a lot harder than i thought too, turns out i have to be both employed and insured by the NHS. Anyway, i'll your latest entries later, best get back to my assignments. All the best;

- Kieran