Sunday, 30 November 2008

Bus encounters

Night shift: Four calls; one declined; three by ambulance.

Stats: 1 RTC with minor injuries; 1 Fractured rib(s); 1 Fall with facial injuries; 1 Abdo pain.

Luckily I am in the habit (as I should be) of checking the tyres on the car before I set off into the world and tonight I spotted a huge screw sticking out of one of them. Oddly, the point was protruding, so either the head of the thing had embedded inside the tyre or it was pointy at both ends. Either way, I wasn’t taking the vehicle out until it was changed, so I found another car and the Hi-Q man was left to do his job. It’s the fourth tyre change on the vehicle in as many weeks.

Two people literally walked into a bendy bus as it turned a corner (I prefer to say meandering around corners ‘cos it takes them a week). They were tourists and were looking the wrong way by all accounts. They were knocked off their feet and one of them, the man, sustained a minor head injury amounting to a large bump at the back. The woman got a grazed knee as her reward. Neither wanted to go to hospital because they had other, more pressing things to do, so they were examined, their troubles and details documented and then let go by the crew.

A pub landlord slipped on cellar steps and lifted into the air for a second before crashing back down onto his back on the concrete. When I arrived there were two members of staff waiting for me but they weren’t pleased to see me. ‘You’ll need something a bit bigger than that mate’, the man greeting me said as he pointed critically at my car.

‘Its all you’ve got for the moment, I’m afraid’, I told him.

The initial aggression with which I was met was down to someone allegedly being rude to him on the phone when he made the 999 call. I wasn’t sure if that was the case or not but I was feeling the heat of it, as if I represented everyone wearing this uniform.

Inside the pub, the landlord sat on the floor with an ice pack on his back. He was having problems breathing without pain and when I listened to his back I could clearly hear the creak and click of a fragmented rib…or possibly two. He wasn’t in immediate danger because his intercostals were doing a good job of splinting his injury. He had no neck pain and no other significant problems but he needed pain relief.

The crew arrived after a failed attempt to get a line in for morphine; he wasn’t interested in trying entonox because he couldn’t breathe in with enough force to inhale the gas. His vein had cheekily come up for the cannula but then ran away once it was inserted – he wriggled a lot too, so those are my excuses for poor performance on this occasion.

I was back on my usual car soon after that – the tyre had been changed and I was no longer in danger of skidding off the road as the result of a sudden blow-out (I hoped).

The next call took me to Tottenham Court Road, where an 86 year-old man had fallen in front of a bus as he attempted to flag it down. He’d stepped into the road to signal it to stop and when it approached him, he panicked and tripped over himself in the rush to get back on the pavement. The fall was witnessed by a few people at the shelter and they were helping him when I pulled up.

The well-spoken gentleman had lost three of his teeth (well, a bridge and two supporting teeth either side) and he kept referring to the gap that now existed at the front of his mouth. Someone had picked them up and wrapped them for me and I was presented with them when I started my obs. They were handed to me like a prize.

There was some bleeding going on and his nose looked damaged. He had no memory of falling and kept repeating himself a lot, so concussion was a possibility. His pulse was irregular and when the ECG was done in the ambulance, I found that he had a Mobitz block. We don’t see many on the road, so it was an interesting graph to take away.

I don’t expect he stayed in hospital too long but at least the accident had given us the opportunity to spot a potential cardiac problem in the making.

Very early in the morning and I was heading out towards Kings Cross to help a 16 year-old girl who’d developed acute abdominal pain and vomiting whilst out with her friends. She had no medical problems and she didn’t drink alcohol. Her pain was genuine and she vomited while I was going through my obs as she stood, bent over, with five of her mates close by.

I sat her in the car but it took a long time to get her there – she was unwilling to walk or change her position because the pain was extreme. When the crew pulled up I gave her entonox but she barely had the strength to draw it in. I felt very sorry for her.

She was put straight onto the trolley bed and taken away to hospital. Her friends went home and she was left in a crumpled heap, crying out in agony. She would need something stronger than gas for this.

Be safe.

Saturday, 29 November 2008

System failure

Night shift: Eight calls; all by ambulance.

Stats: 1 ?Fit; 1 Hyperventilation; 1 DIB; 1 Fall with multiple injuries; 1 Unwell baby; 2 eTOH; 1 Unconscious.

What a strange Saturday night. Maybe the cold, rainy weather is keeping the drunks at home or maybe everyone’s getting into the Festive Spirit by behaving themselves…or, more than likely, fewer people can now afford to go out and buy unlimited alcohol to poison themselves with. Whatever the reason, I found myself working one of the busiest weekend nights without visiting the West End on a regular basis to help scrape someone off the street.

The first call, given as a fall, was an 86 year-old man who had fitted and was now suffering shortness of breath (SOB). His family told me he had recently suffered diarrhoea and stomach pains and that he was normally fit and well. They had gathered in a posh hotel to remember his wife who passed away a few years ago – they do this every year.

His ECG indicated a left bundle branch block (LBBB) and there were other changes on it too, so he was taken to hospital for further investigation.

Choking provokes a Red1 because of the immediate life-threatening nature of the incident. I was sent to a University library where a 21 year-old was apparently choking to death, so every second counted and I sped there as safely as I possibly could, given the rubbish visibility. I arrived and got lost. Nobody was there to wave me down or direct me and the buildings are sprawled all over the place, so I couldn’t identify the right one. A MRU was arriving on my tail and he couldn’t work out the address either. We might get to your location within a short time but if the address is vague or there’s nobody to meet us, another minute could be wasted; it’s frustrating.

An ambulance pulled up just as I found the correct building, thanks to a passer-by who casually pointed around the corner – it was almost a ‘Yeah, your emergency is over there mate’ type of gesticulation.

So, three vehicles and four LAS bods were on scene – more than enough to cope with a choking person. We could save her life – well, we could if she was choking at all. A gang of students rushed out of the main door to meet me as I approached. One of them was carrying the girl as if she had been wounded by a mortar in a war zone; it was all too dramatic. I took one look at her, asked her to breathe in and out and decided that she wasn't dying. Neither was she choking.

The girl was hyperventilating. She’d collapsed in a heap outside the place and a mob of concerned students with absolutely no knowledge of basic anatomy or physiology decide she must be at death’s door. Obviously, because she was gasping, she must be choking. It all made perfect sense to them I guess.

A district nurse dialled 999 and asked for an ambulance to take a 77 year-old man with diarrhoea and SOB (another one) to hospital. He was in bed and certainly seemed to be having trouble with his breathing. The crew took over once my obs were complete and oxygen was given to help him out. Otherwise, he seemed stable for the moment.

Some calls contain so little factual detail that it’s surprising more people don’t die as a result. Sure, plenty of people exaggerate the information they give (as in the choking call earlier) but some play down the need for an emergency response. We’ll run around on Red3 calls for ‘not alert’ or ‘unconscious’ people who are just drunk and we know it but we fail to grasp the problems associated with mechanisms when we receive calls with scant detail but a high index of possibility for serious injury. It’s not the call-takers who are to blame; they do what the computer tells them to do – it’s the design of the system, the software and the uneducated non-clinical method we employ to associate cause with effect.

For example, I received an amber call for a 72 year-old woman who had fallen down stairs but had ‘no injuries except for a bloody nose’. Right; she’s 72 years-old, so no spring chicken (with respect). She’s gone down stairs (that are made of what?) and landed on something (a floor? A bed of nails?). The call detail also stated that it was a ‘long Fall’ which should sound alarm bells for anyone. When I got there I was shown to the patient by a tall man who is a friend of the family. They are Portuguese and the patient doesn’t speak English at all but the daughter-in-law does and she translates for me.

The flat is a complex of rooms in which there are multiple sets of stairs to negotiate, up and down. The hallway in which the lady landed is tight and narrow, cluttered with stuff, so moving her out of there was going to be a nightmare.

She had fallen from the top of six steps without touching any of them – she’d been launched in fact, landing with a thud that was heard from the back room, according to the daughter-in-law. She was found wedged in a small space at the bottom of the stairs with a head injury. I saw a huge bump on her forehead and good size pool of dark, congealing blood on the floor. She was sitting up now but complaining of neck and arm pain. Further examination revealed a broken nose, broken Humerus and multiple bruises around her limbs. Her neck pain was a concern but she had fair movement and refused to sit still so that I could hold her head in alignment.

I called Control and asked them to upgrade the call so that I could get a faster response but I learned that this wasn’t done and so an ambulance was sent on the amber code with no rush.

I can’t write about calls like this without sounding like I’m having a go at Control staff; I’m not – I’m against a system that ignores the clinical assessment of someone on the front line in favour of a grading system that satisfies ORCON.

When the crew arrived it was decided to take the lady out in a chair and not to board her; it would have been impossible and dangerous to do anyway. She consented to this and refused any sort of restraint in any case.

We need to re-think the way we remotely assess a call, based on the information given using mechanisms and a high index of suspicion. That means using clinically trained personnel to take the calls but call-takers do not receive much, if any training in pre-hospital care. HEMS and the MRU desk use this practice to send additional resources to a call and I use it when I look at calls on the Clinical Support Desk – the computer’s opinion takes second place.

New parents with new babies worry a lot about their offspring – even when they have been told that nothing is wrong with their child. A 3 week-old baby with diarrhoea was brought to my attention and I reassured the young parents that she was okay after a full set of obs. However, they thought she had fitted (she back arched when picked up) and I explained that babies do that when they have wind. Recent trips to hospital where a clean bill of health had been given did nothing to reassure them, however and I was reluctant to leave them at home, so they went to hospital for more support.

Club personnel who carry patients out to us because they are unconscious and drunk risk trouble for themselves if anything goes wrong, so I would recommend they leave the patient where they lie until we get there. I wasn’t surprised when my 18 year-old Portuguese (there’s a lot of them in town) patient was carted out as I arrived but I was annoyed. She had drunk way too much and her sobbing friend couldn’t understand why she’d just collapsed in the toilets. She had vomited and was floppy but conscious. In fact, she still had the sense to speak in full sentences to her friend. Every now and then she’d stop talking and slip into a drunken sleep, from which she was awakened by yours truly.

Off she went, friend in tow, to the nearest A&E.

Early in the morning I was despatched to a 32 year-old male who was unconscious and ‘had a bit to drink’. The word ‘bit’ is often the parody of ‘lots’, I find. Further details explained that the house had recently had a fire and so there was no electricity and that meant no light. This was going to be fun.

I arrived as the crew pulled up and we made our way up the dark, narrow stairway using our penlights to guide us – we do have torches in the vehicles but they rarely work. The smell of smoke was still strong and ironically, when we got into the flat, they were using live candles to light the room.

The man was in the recovery position on the floor and his wife and two friends were present. They had been drinking all night and come back here to party and dance around, as you do. While dancing, the man suddenly collapsed and lost consciousness. He had a fit and then his breathing became noisy and slow. When I assessed him his respirations were too slow for life and we got to work on him with the help of a little torch and one of the friends. I had to ask for the candles around him to be taken away – we were about to turn the oxygen on and this would have become a dangerous farce if we’d ignored the risk.

I’ve worked with one of the crew on several calls like this; we communicate well and things get done. He was bagged and I began the process of gaining as much information as possible about his medical history, drinking habits and possible drug use as I put a line in. He got Narcan even though his wife was sure he didn’t touch strong drugs and only smoked occasionally. I believed her but you never know, do you? His pupils were pinpoint and so going down this route to start was advisable.

We remained on scene for about 30 minutes because we had to wait for help, in the form of proper light, from the London Fire Brigade. They appeared as if by magic in healthy numbers and shone their torches where we wanted them. I’m willing to bet they were the same crew that put the fire out in this place.

His wife cried a lot but was able to keep herself together in order to help us. I think she feared the worst and there were a couple of moments before the LFB arrived when he stopped breathing and our support was the only thing keeping him alive. His pulse rate was dropping, so any interference with his airway, which was manually cleared several times, might have invoked a serious bradycardia.

Narcan didn’t change the situation and Oxygen didn’t make any difference to his state of consciousness, so it was time to get going before we had a bigger problem to deal with. I could imagine how difficult his removal from the place would be if he arrested on us, so it was a good idea to get him in a chair and go while he was drawing some breath for himself.

The LFB helped with light and guidance down the steps and my colleagues creaked and sweated as they carried him away. He was put in the back of the ambulance and everything we had was thrown at him; CO2 monitoring, 12 lead ECG, more oxygen, etc.

The quick journey to the hospital brought no change in him; in fact we had to wrestle with his airway a few more times to keep it clear. We also had to temper the bagging to balance his O2 and CO2…and pulse rate (over-enthusiastic bagging can disrupt the gas balances).

In Resus they worked on him some more, took blood, intubated and hooked him up to their machines but his condition remained the same.

I spoke to his wife as she waited. ‘He was always very difficult to wake up’ she said in an attempt to console herself.

I asked about him later and was told he’d been taken for a scan, which was negative. I was sure he’d been suffering a neurological insult. He was now in ITU and they’d taken two litres of urine out of him. I hadn’t given him fluids; he didn’t need any but the hospital, as part of their own protocol, had pumped a litre into him. I wondered if he had suffered renal failiure, although there are many causes of fluid retention.

I got back to a late job and was late home as a result. I still had two more nights to do, so the overtime wasn’t appreciated. The call was for a 38 year-old man who had walked into a bus. He was very drunk and I found him sitting on the cold, wet ground with a shoe off. The bus driver was annoyed that he’d nearly had to go home after potentially killing someone who was just stupid-drunk – I empathised with him.

The police arrived to help and they checked his immigration status (they are good with hunches like this). The ambulance arrived after 30 minutes and I left him to them (and the police).

Morale is very low in the service and pressure is increasing for all of us. Targets dictated by a lazy Government that believe in a nanny state give us no hope for the job sometimes. It’s made worse when human beings are removed from the exercise in the hope that prediction and submissive supposition can replace a good brain and common sense. I will never claim to be the best at what I do – there are better paramedics out there I’m sure but if you tell me your 20 year-old mate is vomiting in the gutter after drinking and he’s ‘unconscious’, I will replace paternalism with scepticism for the sake of the truly ill and injured out there.

Maybe a good scare is what’s needed for some of them so that they realise the risk they take has potebtial consequences and they stop being dependent on an ambulance service to carry their self-imposed burden all the way to an over-stretched A&E department. Or maybe I’m too harsh and unwilling to accept that people are essentially moulded into this reluctance to take responsibility for their own actions.

Be safe.

Friday, 28 November 2008

Dark places

Night shift: Seven calls; one declined; six by ambulance.

Stats: 1 eTOH fall with facial injuries; 1 Faint; 1 Chest pain; 2 eTOH; 1 Sickle cell crisis; 1 Heroin overdose.

Here we go – four nights in a row and another phase of shifts after which I need, but rarely get, at least two days to recover and re-set my body clock. Night shift patterns are one of the main reasons for quitting the profession – love it or hate it.

And it starts with a 45 year-old drunken man who’s fallen outside the Waldorf Hotel and badly lacerated his thumb. The crew arrive with me and together we coax him to stand up and stagger (with support) to the ambulance. ‘I don’t want you guys’, he says. PCSO’s have been hovering over him since he was seen dropping to the ground by a MOP. Now he’s embarrassed that we’ve been called. He’s also useless to man and beast until he’s sobered up and got his thumb fixed.

Back to the Aldwych later on for a 46 year-old woman who fainted in a restaurant. She had a history of passing out in her younger days, she tells me but I don’t want to play down the significance of it until she’s had an ECG, so she’s taken to the ambulance and off to hospital by the crew.

One of our frequent flyers turned up at an underground station claiming he had chest pain. He usually goes for ‘I think I’m going to have a fit’ in order to ring the alarm bells of the general public but I know that he’s been in and out of hospital all week, so I expect he’s decided to change tack. I don’t mean to be unkind to him but he knows what he’s doing and he just doesn’t care.

When I got on scene the underground employees very concerned because he wouldn’t talk to them and seemed ‘floppy’. He soon perked up when he was in the back of the ambulance and assured a trip to A&E; the crew weren’t local, so they had never seen him before. He was happy with that.

A tall 20 year-old vomiting drunken female next – I had the pleasure of meeting her as she lay slumped on the floor of the ladies toilets in a bar. I met her weeping friend too. ‘Is she going to be okay? What’s wrong with her?’ I’m then informed that she’s had a ton of wine at high speed tonight, so there really was no medical mystery here. It’s just a shame they don’t have school lessons in which teenagers who want to grow up and drink like this can be educated in the ways of wine.

Some time into the wee small ones I went on a long drive across town to visit a 35 year-old woman who was ‘not alert’, which means all sorts of nonsense things. I arrived and made my way all the way up to the top flat and was greeted by a very drunk lady who immediately verbally abused me. Her friend was sitting on the floor, just as sozzled, being very quiet (therefore not alert). I asked her why she needed an ambulance and, eventually, she told me she didn’t. Meanwhile, the other lady is hovering over us, shouting and swearing - sometimes at her friend and sometimes at me. She just won’t shut up and I find myself competing with her volume in order to get sense out of the situation.

The quiet drunken lady tells me she doesn’t need an ambulance and that there is nothing medically wrong with her but her mate insists that I remove her from the house. I tell her I can’t force anyone to go to hospital and this makes the loud woman even louder. The quiet woman is just sitting there doing nothing.

I called Control and advised them of the situation and requested that the crew be cancelled. They must have heard the racket the lady was making as she continued her tirade of abuse towards me. The door was open and I needed no excuse, so I asked the quiet lady once again if she needed an ambulance – she said no, so I decided I’d had enough and left. I was followed by the angry woman and she stopped at the door as I stepped into the landing. ‘Excuse me, Officer, or whatever you think you are’ she said with an evil hate-filled look on her face. ‘So you aren’t going to help? You won’t take her away from this house?’

‘Nope’, I replied.

Then I made my way down stairs after receiving an earful of screamed expletives followed by the door slamming in my face. It’s bad enough being abused but it’s worse knowing that I’ve travelled miles out of my area to get it!

I had asked Control not to send anyone to the address unless the police were going too but later on I was told that a crew had been sent automatically by FRED without any warning to them about what had happened to me. They, of course, were treated to the same abuse and left the scene quickly.

I’ve said it before and I won’t be convinced otherwise; a good proportion of the calls we get to police stations for people held in custody are non-starters in medical terms. We are the excuse they need to get out of the cell and into a hospital bed. For some it’s even a chance to do a runner. That’s why the 31 year-old man who claimed to be suffering Sickle Cell Crisis was handcuffed as he was led to the ambulance. Right from the start I wasn’t convinced of his authenticity – neither were the officers escorting him, the custody sergeant or the hospital staff nurse. Pain, of course, is immeasurable and therefore easy to fake and a real crisis can be very painful but his sham behaviour poured scorn on the very real suffering of those who need help when they sickle.

The last call of the night took me to a narrow, dark alleyway, at the bottom of which lay a man’s body. I was led there by a drug dealer who’d run out of the shadows to get me as I waited at my RV point for the police to back me up. I wasn't supposed to be going in there just yet but it was too late now and I was on my way into that place without any protection. It was an uncomfortable experience.

The dealer told me that the guy had bought and injected Heroin, then slumped into unconsciousness. This is quite normal but if a dealer looks worried about the state of a punter, then something was awry. I was either being set up or the guy lying on the ground down there was dead…or close to it.

I drove down the alley and parked far enough away to get the space I’d need for an escape if I needed it. There was no way I could turn my car around in a hurry, so I’d have to use it as refuge...or simply run.

I went up to the body and saw that he was breathing but very badly. His respirations were slow, shallow and bubbly. There was foam coming from his mouth and he didn’t respond to me at all. I grabbed what I could from the car and saw that my colleagues were on their way down to help. The ambulance couldn’t fit inside the alleyway, so they’d parked up in the road and were on foot. I shouted for them to hurry because I don’t think they realised what was going on.

I turned the man onto his back and, with the help of the crew, began the routine of saving his life. He was ‘bagged’ and Narc’d, as is the usual drill in these circumstances. The police turned up just as we were getting serious and they assumed he wasn’t going to make it. The place was cordoned off and CID were brought in, which I thought was a little premature.

We got him on the trolley bed and rolled it all the way down to the end of the alley and into the ambulance, where he began to stir. Another bolus of Naloxone woke him right up and when I left he was sitting up and singing like a canary…well, you know what I mean. It was a bad-start job that turned itself around in less than twenty minutes. Sometimes you wonder why you take risks for this kind of stupidity.

Be safe.

Tuesday, 25 November 2008


Day shift: Eight calls; three declined; five by ambulance.

Stats: 1 Head injury; 1 Abdo pain; 2 Chest pains; 1 ?GI bleed; 1 ?EP fit; 1 Palpitations; 1 COPD with DIB.

A 59 year-old lady tumbled as she left a bus and hit her head on railings, causing a large swelling. Police were on scene and the crew was with me in five minutes, so all I had to do was gather my obs and hand her over for hospital.

Then I went to a local call and found a 19 year-old female sitting on a step inside her University Campus building, crying and nursing her painful abdomen. The security guy, who was just outside the entrance, took no notice of her and people practically stepped over her as she sobbed at the bottom of the stairs. She was on her period and its possible she was suffering a particularly painful episode but that doesn’t reduce the reality of her pain and it was a shame that nobody wanted to stop and ask her if she was okay. Maybe they were used to girls crying on those stairs.

A call given as a 42 year-old male was a female in fact and because I was looking for a man I almost drove past her as she waited outside a train station for help. She had chest pain and kept rubbing her breast to soothe it, something I haven’t seen done in this context. Again, she was on her own and nobody seemed to care. It was rush hour, so I guess there is a time and a place for caring.

After that I went to see a regular patient for whom a doctor had called an ambulance, stating she possibly had a GI bleed. When I arrived at the flat, she told me she didn’t have any problems and that her doctor ‘worried too much’ about her. In spite of her denials and because of the low blood pressure I was recording, I decided to call the GP myself and get the facts. The crew was on scene as I made the call and her own GP told me that she hadn’t been contacted at all. Then I tried the on-call doctor and this time the story became clear. She had been visited the night before when she became unwell and the doctor had told her that she was concerned about the low blood pressure and recent spate of malaena. She was advised to go to hospital but refused, thus the call to us the next day.

The patient spoke to the doctor on the ‘phone while I was there and pulled faces and made gestures that intimated her feelings for the professional on the other end of the line. Then she hung up on her.

She flatly refused to go and even though she had been warned that she could be found dead sometime soon (by her GP and us), she still said no. We had no choice but to leave her where she was and get the paperwork signed. No doubt I will see her again – dead or alive.

Another patient to refuse a trip to hospital had suffered a fit, according to witnesses. The school teacher was six months pregnant and had passed out but the description of the incident given by her colleagues in the Staff Room was closer to an absence (this used to be called petit mal). She felt fine when I arrived and insisted that she should carry on with her day.

The kids outside were extremely interested in what was going on and asked me if I was delivering her baby. On my way back to the car I told them it was a boy and it was to be called Brian. This caused a sudden upsurge of excitement and the rumour spread like wildfire before I’d reached the gate.

It was turning out to be an odd day with the third refusal in a row. A 40 year-old man with chest pain decided he wanted to continue his coach journey to Poland, despite collapsing and causing great concern among his fellow passengers. His father had died a few days earlier and he was on his way home for the funeral. His chest pain could have been the result of anxiety but there were changes on his ECG and he was strongly advised to go and get it checked out, rather than risk a long journey by road. I understood him though – I would want to be at my dad’s funeral if I had been away when he died. The poor man was working in the UK and sending every penny home to his mother so now he had no cash and no means of taking the trip later on.

He signed the PRF and was allowed to go on his way – he just about caught the coach as it pulled out of the station. I hope he made it without any drama.

A 27 year-old Soho prostitute suffering palpitations took 45mg of Valium to try and calm her heart down. She already had an anxiety problem and worried that she’d taken too many. I reassured her as she sat on the step of her bed-sit home and the crew took her for an ECG which, apart from the tachycardia, was normal.

I almost made it home but I got a late job and was off to see a 57 year-old man with COPD which had suddenly become exacerbated. I knew the man and I knew he was very fragile, so I tried to give him more oxygen but he didn’t want the mask on his face. His nasal cannula was only delivering 2lpm and that wasn’t enough. I couldn’t nebulise him either because, again, he refused the mask. I cranked up his oxygen to 4lpm on his home cylinder and hoped the crew would be there quick because his sats were very low and his condition was deteriorating. He was panicking. ‘I’m going to die’ he said repeatedly.

As his anxious family stood round I tried to calm him and prepared to do what was necessary if he stopped breathing – a strong possibility in these cases. The crew arrived and he was taken to the ambulance where he relented and allowed a nebuliser to be put on him. His condition improved slightly but he was still using accessory muscles to breathe and looked ready to give up, so he was taken to hospital for further treatment.

I take people with real breathing problems seriously; the look of a person, they way they posture and behave will indicate the severity of their condition, whether we gauge that through our instruments to be serious or not depends on how we see the human being that is trapped in the desperate fight to catch a breath. Until you have been there yourself, it’s dangerous to assume that a high saturation means they are ok.

Be safe.

Monday, 24 November 2008

All fall down

Day shift: Nine calls; all by ambulance.

Stats: 6 Falls with head injuries (1 with broken nose); 1 Knee injury; 1 Hyperventilation.

This ambulance shift is with Emma and she is a good friend of mine from a few years back. Our first call is to a 45 year-old male who’s lying in the street with an ‘upset stomach’ – this was designated a Red3 and that was the description given. I get upset stomachs but I don’t believe it’s an emergency. When I arrive I realise why it’s been categorised that way; the call has come from the police.

I also know the man on the ground – he is a gel-drinking alcoholic and he can be very aggressive – not violent, just angry. He also smells very, very bad and often defecates into his trousers, leaving the mess there for days at a time. This was not the best breakfast start to the day for us.

Predictably he bemoaned his life and predictably he began to raise his voice as he became more and more frustrated with my crew mate’s questions. Emma has the patience of a saint; I don’t – so he was told to calm down and stop raising his voice.

‘I want to die’, he kept repeating, ever louder. I feel the same - the smell is overpowering at times.

When we get to hospital (police officer on board just in case) he is put into a secure room but he’s not happy at all. The last time I see him before I leave is on the CCTV monitor – he’s curled up on the sofa with a blanket around him - complaining about everything and everyone.

Our next call, soon after, is for another gel-drinker and the evidence is still on the ground next to him. A small bottle of orange, mixed with alcohol-gel is testament to his current condition. The 70 year-old man was seen to collapse and land on his head, opening it up at the back. Two helpful ladies from a nearby coffee shop tended to him until we arrived. He smelled the same as our previous patient. Perhaps the gel-alcohol gets into the urine and gives it that ‘special’ aroma. He hadn’t been incontinent, however, so it was a less stressful dilemma for the olfactory nerves.

He was semi-conscious and hypothermic (32c), so a couple of blankets, some warmed IV fluids (we don’t have a fluid warming system, so I use the ambulance heater) and a blue call to hospital were in order. By the time he reached Resus, he was a little more alert.

Then we went south to the aid of a 46 year-old man who fell in the street as a result of a ‘dodgy knee’ he’d twisted a few days before but ignored. One look at it confirmed that it was sprained at best – fractured or dislocated at worst. His leg was rotated at the knee so that it deviated from its natural line – it was obvious when he lay on the trolley bed. No wonder he’d been unable to walk on it.

We splinted it and gave him pain relief – entonox does the trick for this sort of thing. This time he would have to go and get it sorted.

We were sent on Active Area Cover (AAC)…or stand-by as we used to call it and, as if to prove a point, the next call came from just down the road. A 64 year-old female had fallen on a bus and had a head injury. AAC is fairly new and the idea, combined with call-connect, in which an ambulance (or solo) is despatched as soon as the address of the call is confirmed, is to speed up our response times to your emergency, perhaps saving one or two minutes. That’s all very nice and I appreciate that we need to be with you as soon as possible but a system based on prediction and human folly is bound to fail sooner or later. For the time being it seems to be doing its job. Either that or we are being sent to a specific location and calls are being setup for us. That’s too far-fetched and very cynical of me, I know.

Anyway, despite this wondrous technological advance, they still managed to get the wrong location and wrong bus number, so we wasted a minute trying to locate our patient in the heavy rush-hour traffic of Oxford Street. See? You just can’t knock human intervention.

The woman was fine; she’d fallen onto the back of her head when the bus braked hard to avoid hitting two kids as they darted across its path. Fair enough, the driver had to avoid the collision and maybe she should have been seated, as per the instructions for every passenger BUT I really wish he hadn’t said that he ‘broke’ hard to avoid hitting them. There was worse news for my ears, however, when the police officer attending the scene said exactly the same thing. It irritated me as much as seeing an apostrophe hanging over an S in a plural. Scottish and fussy about my English, that’s me.

We went back to Oxford Street later on to tend to an 84 year-old woman who’d tripped on a defective paving slab and fallen onto her nose. She had two hands full of shopping (and they say there’s a recession), so she was unable to stop herself landing full-force on that facial organ. ‘I heard it crack’ she said with a soft, smiley Irish tone.

The poor woman’s septum was deviated so far to the right that she looked like a prize fighter with a story to tell.

The strangest call of the day next and a FRU was on scene with an 81 year-old lady who woke up in the morning, had a bath, brushed her hair and felt something wet on her hands. She looked down and realised she was bleeding. The FRU pilot examined her and found a huge open bump at the back of her head. It looked like she’d been mugged with a cricket bat, yet she had no pain and no idea how this had occurred.

She had a GCS of 15 and all her obs, apart from her blood sugar, which was high, were normal. She wasn’t diabetic, so her BM was a little suspicious and we searched our minds for a connection. She hadn’t fallen, hadn’t been hit BUT she was taking Warfarin and that seemed to lead me to a reasonable possibility, although I needed a mechanism, like a fall or knock to the head to support it.

Obviously she was bleeding heavily from the wound and so it was dressed tightly and she was taken to hospital where no doubt higher paid people with more time on their hands would work it all out.

If you see an ambulance parked up with blue lights flashing and you are a multi-drop driver, keen to make that urgent delivery, please don’t park so close to the back of the ambulance that the crew can’t lower the ramp to take a non-walking patient on board. If the lights are flashing we are definitely working – not queuing for a coffee and cake at the local cafĂ©.

A florist decided he’d unload what must have been dreadfully important plants directly behind our vehicle. He was so close that our ramp would have settled on his bonnet, had I been annoyed enough to go ahead and lower it anyway. Our patient, a lovely 85 year-old lady who’d fallen on the escalator at a John Lewis store, was being wheeled out with a head injury. To save us lifting her up the steps of the ambulance, my plan was to put the chair on the lift and gently (safely) raise her into the vehicle that way. She was unsteady on her feet, so it was the kindest thing to do. Mr Florist had other ideas and not even the sight of her having to be walked on wobbly legs made him feel guilty enough. Thank goodness we weren’t resuscitating someone.

We took the lady to hospital and she was directed to the waiting room because there were no beds. We wheeled her next to our last head injury patient, the Irish lady and they both got chatting. I suggested a game of cards.

A quick and easy hyperventilation next. A 65 year-old was having a panic attack at an art gallery and we spent no more than a few minutes calming her down after the MRU bod had started the ball rolling.

The last job came from just around the corner as we waited at hospital. A 12 year-old boy had fallen on his head. He was described as ‘dizzy’. That was under-selling it; he’d been aloft on his friends shoulders next to a busy road – they were larking about and he took a tumble onto the pavement. His tooth pierced his bottom lip, leaving a ragged tear and hole in it as he met the concrete with his face. He hadn’t been knocked out and his mates (there were a lot of them) could have walked him to the hospital but these days, everything is an emergency, right?

Be safe.

Sunday, 23 November 2008

Bad starts and funny bones

Day shift: Eight calls; one false alarm; one declined; six by ambulance.

Stats: 1 Knee injury; 1 RTC with minor facial injuries; 1 cardiac arrest; 1 sprained ankle; one faint; 1 fall ?cardiac; 1 fall with knee injury.

I’m doing my usual couple of shifts on an ambulance, so I have a crew mate each day and, for the first time in a while, I’m enjoying the change. Ambulance calls are much more varied; I never go to Green category calls in the FRU and I don’t do patient transfers. I also get to spend more time with my patients and that’s often the most satisfying part of the job.

My first shift is with Dave – I’ve never worked with him before but I have known him for a few years – he’s a thoroughly nice chap and totally professional.

We had a routine kind of start to our day with a 30 year-old Spanish woman who stumbled whilst running up stairs at work. She got a banged knee for her trouble and now she could barely walk on it. It was more than likely just bruised but knocks to the knees can be very painful, so I empathised with her misery and we took her to hospital.

This was followed by a 9 year-old girl who was on her way to school when she stepped out in front of a cyclist as he sped along the road. She ended up with cuts to her cheek, mouth, nose and hands. The handlebars of the bike struck her across the face and she was obviously upset. Her father had to be dragged out of bed to come to her aid when other family members called him. He was calm enough about it all but he told me that cyclists were notorious for speeding along that particular road, despite the fact that children use the route to get to and from school.

Some calls just aren’t what you expect or want in the early morning. A man had collapsed and was ‘unresponsive’ in McDonalds. We know the particular restaurant well and we know the locals who visit it, so our assumption was simple; it was a known alcoholic or drug user who’d lost himself on the floor. We would go in, wake him up and walk back out with him, arm in arm no doubt.

We walked in and I got to the man on the floor first. He wasn’t known to me and the staff members present weren’t too worried about him. A customer had a lot more concern on his face – he was the one who tried to get him to respond with no luck.

The man was on his back and he wasn’t breathing. I felt for a Carotid pulse and got a very weak, thready impulse against my fingers. He was peri-arrest.

As the equipment began to gather around his body, he arrested and his ECG showed asystole.

Nobody knew the man and there was no indication of anything untoward when he walked in. He sat down and then fell down by all accounts. The witness, who continued to help us as we started working on him, said that he’d gone to the toilet but there was no real historical information to help us work out what may have caused his sudden demise.

I asked the McD’s manager to call 999 and request a second crew (this is normal practice) and off he went. We continued to go through the sequence of actions needed to save the man’s life; CPR, drugs and more CPR but his rhythm didn’t change and no shocks were given.

The crew arrived but seemed completely surprised by what they were seeing. The paramedic told me that they had been given this as a ‘second patient’, so they thought they were simply coming to assist with another casualty. Right from the start, the verbal communication of what was going on in that restaurant was inaccurate. I even had to request that they clear everyone from the basement area because people were still munching their breakfast buns as we jumped up and down on the man’s chest. Then I had to ask for the cheery music to be switched off because a) I couldn’t hear the defib above it and b) it was entirely inappropriate and was cheering nobody up.

If you are a McD employee, please do a first aid course and learn how to relay messages. No offence if you are already switched on but it is all about communication.

We stayed on scene trying to stabilise the patient but nothing changed, so we blued him in and the work continued in Resus. Unfortunately, he was pronounced after twenty minutes and still nobody knew why he’d gone. He was only in his forties.

Green calls can wait a while before any help arrives and our next patient, a 19 year-old Danish girl had to endure two hours with a badly sprained ankle at the hotel in which she works. A heavy drawer cabinet was being pushed past her but the clumsy maintenance man failed to realise that an obstruction to his path was the young lady’s foot, so he pushed harder to clear it. She twisted herself to get free of it and damaged her joint in the process.

We arrived to find her sitting, leg raised, behind reception. She wanted to go by taxi but the hotel management decided an ambulance would be better. Not really…she would have been in A&E faster by cab.

She was a pleasant, chatty girl with excellent English and a love of texting that kept her pre-occupied during the journey to hospital. Opposable Thumb Psychosis I call it.

Comical calls are few and far between and the 999 request for a cancer patient who was not answering his door and was seen in bed not moving by a worried neighbour turned out to be one of those things. A MRU colleague was on scene with police and the door was being forced. The patient could apparently be seen in bed through a little window but he cared not for the commotion outside his door…apparently. When the door broke I went into the bedroom and approached the bed. A quilt was wrapped in a roll and I braced myself for the purple body it contained. Then I lifted it and saw…the sheet underneath. The bed was empty. Nobody was home and now the poor guy was going to return home to a smashed door. The police would inform him and he’d get a replacement but it would be a shock.

The shaken and very pale neighbour waited outside and fully expected us to come out shaking our heads in that ‘there’s noting we can do for him’ way but the shakes were contrary to his fears and we quickly reassured him that he’d done the right thing. Even I was convinced up to a point.

A 73 year-old lady declined to go to hospital when she fainted three times in a busy department store. ‘I’ve been fainting all my life’ she told me. We did all the necessary checks and pronounced her fit and well. She’d fainted, got up too fast, fell down again and repeated that action once more for the benefit of the worried staff who were lovely with her throughout.

Another elderly fainter was an 81 year-old man who tripped in the street, fell, was helped up and then passed out further down the road. He had a head injury and was confused about what had happened, although he had a clear memory of the events leading up to it. His ECG revealed a possible heart block and that would certainly explain the falls. We took him to hospital and his wife joined him a few minutes after we arrived. She looked resigned because, although he had told me this had never happened before, she told me that it had…several times.

Last call of the day and it was a cyclist who fell off her bike. She had a painful leg and when I examined it the bone seemed to be protruding. In fact, when I touched the area it clicked back into place and she got instant pain relief. She told me that this bone had done the same thing before but the location of her ‘loose bone’ was high up on her tibia, near the knee. Unless she was born with a deformity or the bone has been broken for a while, the movement was quite unnatural.

By the time we arrived in hospital the pain was virtually gone but she still couldn’t put weight on it. Good idea not to, I think.

Be safe.

Thursday, 20 November 2008

Remote control

A few months ago I was promoted to the role of Clinical Support Advisor (CSA). This is an off-the-road position and I’m proud to be part of the small team that mans the desk in Control 24 hours a day, 7 days a week. The role involves giving advice to crews and Control staff on protocol, guidelines, drug use and many other aspects of the job.

I work on this desk as and when I can and have so far found it to be very different to my ‘normal’ routine in that advising from a remote position can be a lot more difficult than being on scene. On one call a crew requested support in making a decision not to resuscitate a terminally ill patient who was about to go into cardiac arrest at home. Her family were adamant that no action should be taken to revive her and I waited on the line as the lady stopped breathing and eventually slipped away in bed. This sort of decision, as you know, is difficult for me because my instinct, like that of the crew on scene, is to carry out my perceived duty of care but it was somehow easier to deal with the problem from afar; the facts of the matter were clearer because I wasn’t in the unenviable position of having to feel the emotions within the environment.

The role is one of support and not superiority over crews and I’m comfortable with that – the decision-making process is faster and needs to be 100% accurate because the CSA’s head is on the block if the wrong advice or information is given to colleagues, so in that respect, we risk losing our jobs on a more frequent basis. Having said that, we too have a line of support if we are unsure and can refer a query further up until it reaches our Clinical Director.

Watching calls coming in and listening to how they are handled by the call-takers gives me another perspective and it’s healthy for me because I can see both points of view. I can also see how badly the system fails us when a patently obvious medical problem is overlooked by the press-button processes and how innocuous or just-plain-stupid calls are blown out of proportion and turn Red as the computer decides to panic. The CSA’s can upgrade or downgrade calls at the touch of a button but only if we can justify doing so…and we’d better be right.

I also hear the abuse levelled at the call-takers on ‘the nines’ – angry people, sometimes understandably, simply don’t realise that questions have to be asked and that time is needed to complete the data input. An ambulance will be on its way but a lack of information is one of the reasons my colleagues and I complain when heading to vague calls. This is the root of it all; quality of input and that’s mostly down to the caller. Although there will probably never be an answer to the human issue of 999 frustration, this blog and the others that exist should go some way to educating the public about the way their emergency system works.

Have a read at Nee Naw and other despatcher blogs for more insight.

Be safe.

Friday, 14 November 2008

System abuse

Night shift: Eight calls; one assisted-only; seven by ambulance.

Stats: 1 RTC with leg injury; 1 RTC with head injury; 1 Chest pain; 2 eTOH; 2 EP fit; 1 Fall with head injury.

It’s raining and it’s dark and the RTC’s start coming in thick and fast; forty across London within the first hour of my shift. I got two of them.

A 6 year-old Arabic boy is hit at low speed by a bus as it pulls in at a stop and a fight breaks out between the father and the bus driver. I get updated on the way that there is a problem and that I should be cautious when I approach but the police are on scene when I arrive and a CRU colleague is attending to the little boy’s cuts and bruises (to his leg). I walk up to him and ask what I can do to help and behind me a little war breaks out.

A relative (probably the father) is punching and pushing the bus driver. A lot of shouting is going on and I try to calm them down. The police are busily cordoning off the area and one of the officers is helping my colleague so I decide the role reversal needs to be checked – I ask the officer to go and contain the situation because it threatens to spill onto us all. Then I take his place.

The child isn’t seriously hurt but the cut leg is obviously upsetting for him and the family’s aggressive reaction to the accident is heightening his emotions. None of us are helped by the fact that no English is being spoken and attempts to communicate calm and reason are being thwarted by a language barrier.

When the crew arrive the violence has subsided and been replaced by a threatening atmosphere – like an evening on the North Korean border. We scoop the child up and get him into the ambulance. HEMS are on scene, even though they were cancelled but they decide they have nothing to contribute to such a minor injury. The ambulance clears the scene and I hail a cab for the rest of the large family so that they can go to hospital with him. Then I clear off too.

The next RTC, as if on cue, involved a car and a cyclist – not a happy combination. This time I arrive to find another kind of confusion. A colleague is rendering aid to the cyclist, who is standing up and seems confused and bewildered. My colleague tells me that he is single (has no crew mate), despite the fact that an ambulance is on scene. So, he’s not actually in commission for this call; he just happened to be passing by on his way back from re-fuelling the vehicle.

I watch the behaviour of the woman who’s been hit and decide she has a head injury. I can’t see it – all she has is a small bruise on her cheek – but she is not behaving normally and I’ve seen a lot of this brain-insult associated irrationality, known simply as cerebral irritability.

HEMS arrive just as I escort the young woman (probably in her early twenties) to the ambulance. The doctors are surprised to see me again and a short exchange takes place in which the notion of following each other around all night becomes plausible. They are in a gang of four tonight; two doctors, a paramedic and an observer. A gaggle of HEMS.

The young woman’s behaviour becomes more and more unstable as the team attempt to calm her. She refuses to get into the ambulance, so spends a lot of time sitting on the step with a doctor chatting to her and trying to treat her. She’s resisting his attempts to cannulate her. ‘I just want to go home’, she cries as the needle enters her arm. She’s clearly scared but she’s also confused and doesn’t actually know what’s happened to her.

There is a contra-flow cycle lane on this busy road and it’s one of the most ludicrously dangerous ideas I’ve ever seen. Drivers must look both ways when turning left or right at the junction...not only on the road but as they cross the cycle lane. It’s an unnatural and difficult to remember action – it goes against the brain’s driver-training functions and it’s clear the thing was dreamed up by a non-car driver.

The cyclist was hit as the car drove across the lane and into the side street. He probably wasn’t looking both ways or his mind was confused by the need to do so as the rain fell and the light faded. Driving conditions are bad enough tonight without the added danger of a moronic contra-system. She was probably hit hard because the car hadn’t braked...or she had simply slammed into the side of him and gone over the bonnet. Whatever had taken place, her head had hit the ground and her helmet had flown off. At the very least she is now concussed. At most she is bleeding inside that little dome of hers.

Once she is calmed and on the trolley bed (she fought a bit and struggled against the oxygen mask) the doctors decide she needs to be managed properly, so they are going to put her to sleep. Another ambulance, with a crew, are on scene now and there are enough of us to help with this. More cops and brought in and the entire road is closed off because we have to do this out in the street – our new vehicles don’t allow for the trolley bed to move to the middle of the floor so that we can get all the way around it.

I rope in a few volunteers to act as umbrella holders because the rain is now falling quite hard. We have no umbrella but we have a sheet and it can be stretched overhead as the work goes on underneath it.

The girl is brought out and she is tearful but calm. All the equipment for RSI has been laid out on the road and one of the crew has been assigned the job of applying cricoid pressure as the tube goes into her throat. She knows nothing about this and she lies there, looking up at the sheet overhead, wondering what’s going on. ‘What are you going to do to me?’ she asks the doctor. ‘We’re going to get you to hospital’, he calmly replies.

A few seconds later and she’s asleep... a few seconds more and she’s paralysed and unable to breathe for herself. The tube goes in and the paramedic starts to ‘bag’ her. Now her life is wholly dependent on the skill of one person at her head all the way to hospital. I join a cacophonous convoy as it speeds to where she urgently needs to be.

I came across the ‘chest pain’ man that I’d dealt with at the train station the day before. I was called to a 55 year-old with chest pain at a bus stop and there he was, with a few concerned people around who’d called an ambulance because he’d sat down, then slumped as if in pain but without any of the real signs you see with such distress.

He recognised me and saw my expression of doubt when I approached. Remember, this guy told me he suffers from angina but he didn’t know how to take the spray. He wasn’t carrying it as he should the day before and here he was once again, supposedly in pain and with no spray. I’m to believe he went to hospital the day before, got ‘treated’, went home and then repeated his actions all over again the next day? Sorry but at the risk of sounding completely unprofessional and uncaring, I believe I am watching the development of a new frequent-flyer; a man with nothing physically wrong and who will be calling ambulances (or having them called on his behalf) because he wants to go anywhere else but home.

Of course I regret that people should be pushed to such desperate actions and I completely understand it when a homeless person is trying his/her luck but this guy is going to cost someone their life when he uses up a perfectly good FRU, ambulance and crew for nothing.

A 30 year-old man who was ‘not alert’ (often code for ‘drunk’) was being attended to by the crew when I arrived and he couldn’t have been more alert if you loaded him with caffeine. ‘I’m okay!’ he shouted at us before storming off. Some people just don’t care why we are there.

Three young ladies on their way out stopped to help a 30 year-old man that had been fitting in the street. They called an ambulance because he had been going for too long and they were worried but when I arrived (my break was interrupted for the call) he was up and walking about, although he wasn’t quite 100% recovered yet. The ambulance was right behind me and I thanked the girls for helping as he was taken on board. They smiled and continued their journey to a night of fun and alcohol (no doubt).

Another 30 year-old, this time a female, was collapsed and semi-conscious on the ground outside a night club in the West End. Her friends were with her and two of them were crying and getting completely wound up about the state of their mate. The girl on the ground was drunk; she’d downed a bottle of champagne or two – well, she’d been drinking the stuff since 4pm and it was now 3am, so she’d had a few. She also had a heart condition (SVT), so she had to be given an ECG for good measure when the ‘booze bus’ arrived to pick her up.

During my obs a street-dweller passed by and I accidentally bumped into him because he was walking too close to the area in which I was working. ‘Don’t push me!’ he yelled, raising his fist in a threatening manner. I didn’t even bother to apologise because I had other things to do but he insisted on continuing his little rant until one of the patient’s friends – one of the crying girls – recovered enough to tell him to ‘f**k off’. Nice exchange, I thought.

As the patient was being lifted onto the trolley bed I saw a bystander attempt to take a photograph of her on his mobile phone. I stepped in front of the lens and told him what I thought of him. The doorman took the camera from him and deleted the pics he’d just taken. This young girl, regardless of her state, was half-naked and helpless. She was still entitled to her dignity and, even though I deplore stupid drunkenness, I find it completely unacceptable for anyone to take photographs of an individual who can’t say no to it. Sometimes a drunken person’s mates will take pictures but for anyone else to do it, regardless of who they are...well it’s thoughtless.

Our elderly fallers are still ranked quite low on the emergency response scale and I went to a 74 year-old lady who’d fallen at her care home, bumped her head badly then lay on the floor for almost an hour waiting for me to get there. She had to crawl to the emergency cord to alert the staff and by the patient’s account they took their time getting to her. Then I came along 20 minutes after they’d called an ambulance because, on a weekend night, her needs were categorised below those of an 18 year-old drunken idiot.

The poor woman’s head was very swollen and soft at the back but she was in good spirits and chatted to me until the ambulance arrived and took her to hospital.

I only had to assist on the last call of the shift when a 19 year-old girl fitted in a shop. Her friend was on scene and so was the crew, so I had little to do. Off she went to hospital and off I went...home.

Be safe.

Thursday, 13 November 2008

With friends like these...

Night shift: Four calls; one cancelled by caller; two assisted-only; one by ambulance.

Stats: 1 DIB; 1 Hyperventilation; 1 Drug O/D

A freezing night and my car had a large nail embedded in the tyre, so I trundled around in another, older vehicle – an Astra with a bit more kick than the Zafira – until it was repaired. Unfortunately, the wrong tyre was changed and I had to wait (and trundle) until the problem was finally solved. That meant going back and forth a few times and carrying my bits and pieces from one vehicle to the other.

An 86 year-old man with severe shortness of breath (SOB) after a fairly new pacemaker had been fitted needed to go to hospital because his sats were on the floor. He was also running a temperature and had been vomiting. His wife decided to stay at home as he was taken away to recover.

Then a dodgy call at a block of flats in which the tenant, a drunken Glaswegian woman denied any knowledge of us being called for the supposed chest pain at the address. I checked the flat number with Control and they called it back but the same woman answered and she still denied calling us (funny how we had her number then). I was told to wait outside and not go near the place because it was all a bit suspicious. The flat had been in total darkness when I knocked on the door and that always makes me a little nervous – I usually step back a foot or two just in case.

The second call-back produced a male at the other end of the phone and Control told me that he’d said he was in another flat (the one next door) and that no ambulance was required. All a bit idiotic when you think about it. How would he know? So, I left the scene and left them to it.

Later on a 35 year-old man with ‘breathing problems’ turned out to be hyperventilating. He walked down the stairs of his building after his wife brought me in from the street. She windmilled me as panicking people do but the man had nothing wrong with him that a few minutes of breathing exercises wouldn’t sort out. The crew saw to that as I left.

It was a quiet night because another FRU was covering the area and my colleague had been running around all over the place by his account, so I got a bit of a cheeky rest in between calls.

So the shift ended with very little going on, with the exception of the 25 year-old drug addict who was seen and heard falling down stairs on an estate by two passers-by who happened to recognise him. They called an ambulance because he kept fainting and I arrived in the wee small hours to find them propping him up on a bench in the street.

They seemed genuinely concerned about him and insisted on staying as I checked him out. The crew was on scene fairly quickly and all I’d established so far was his name.

‘What have you taken tonight?’, I asked shortly after realising he was a street face and known drug user.

‘Lots of things’, he replied before lapsing into a floppy trance.

I woke him up and said ‘You keep passing out’.

‘That’ll be the Valium’, he informed me.

His was a familiar accent – he was from the East Coast of Scotland – probably Edinburgh and he’d travelled here in search of better times I guess.

‘So what have you taken then?’, I asked him again.

‘Heroin, crack and Valium’.

It wasn’t until we’d walked him on board the ambulance that he specified the amounts and it was clear he’d done himself no good but he was clear about not wanting to go to hospital. His biggest fear was that I’d Narc him and reverse his fun. The Valium was a different matter, though and he confessed to having taken 60mg, although he probably had a high tolerance for such doses.

His friends outside had insisted on waiting for him. In fact, he only came with us to be checked out because he was promised they would be there and would take him wherever he needed to go when we’d finished.

I know that drug addicts need a lot of money to feed their habits but what he told us in the vehicle still shocked me.

‘I need £400 a day but today was a crap day for earning, so I scored less than I usually do’.

£400 a day?! Incredible, he can’t be making that sort of money from begging, so he must be stealing or dealing…or both. I'm obviously in the wrong job!

He adamantly refused to go, despite out best advice and collapsing onto the floor of the ambulance for good measure. He had capacity and he signed the crew’s PRF, so that was that.

I went outside to tell his mates that they could take him away but they were nowhere to be seen. They’d cleared off without a word, even though they’d promised him they’d be there for him. In the end, he hopped out of the ambulance and jogged off down the road on his own.

What’s an honest drug addict got to do these days to gain friends he can trust?

Be safe.

Whisky night

Night shift: Nine calls; one treated on scene; one refused; the others by ambulance.

Stats: 1 eTOH and unwell; 1 Faint; 2 just plain eTOH; 1 Assault with facial injuries; 1 Chest pain; 1 Hypoglycaemic; 1 Back pain; 1 Overdose.

For the first time in my working career I was late signing in. The traffic was diabolical all the way from my home to HQ and it took me two hours to get through it. I don’t like being late and I get very wound up when I am. So, I was tense to begin with.

And just to cheer me up I get a call to a Salvation Army ‘soup kitchen’ to help a 34 year-old Polish alcoholic who thinks he might have a fit. He was agitated and the place was full of people queuing up for dinner. He spoke very little English and a translator told me that he was epileptic, although he had no medicine. At one point his friend ranted at him in Polish and I was told he’d said ‘it’s the drink that’s doing this to you’. Too late for the advice now, I thought.

At no point did he have a fit but the fact that he felt like he was going to have one, combined with his continuing agitation, as well as his insistence that he needed to go to hospital meant that he would do just that. The ambulance arrived just in time because, quite frankly, I’d run out of obs and conversation.

I wasn’t required for a 20 year-old female who’d fainted in the street. I’d gone right past her in the car anyway and by the time I did the loop required to correct my mistake, the ambulance was on top of the job.

In the West End, as the pre-weekend drinkers start to practice for the ‘big one’, two 18 year-olds waited in an alley until I arrived, protected by the doorman of a nearby club and a private medic whose first words to me were ‘they’ve been drinking. She thinks her friend is unconscious and not breathing’. It was a sarcastic remark and the less drunk of the two girls felt insulted by it. ‘That’s just nasty’, she told him.

Her friend lay in a pool of vomit and sputum after helping herself to half a bottle of whisky, according to the sober(ish) one. ‘It was only a small bottle’, she said in defence of their stupidity. They were both too young and too small in stature to down that much spirit without punishment.

The crew arrived and a hospital gown was quickly thrown over the drunk girl before she was taken onto the ambulance. Now, that’s smart thinking.

I don’t see many assaults where a female has harmed a male, so this was an unusual call. The 26 year-old man had allegedly been glassed in the face by his girlfriend (now his ex I think) after some sort of argument or dispute. She’d settled whatever it was by pushing a wine glass into his head, cutting all around his eye as it shattered on his face. The cuts were deep and nasty, one or two of them were still actively bleeding and a spatter of blood lay under a bar stool near the door in testament to his girlfriend’s rage. In my experience women only get that angry when they have been terribly hurt…or maybe she was just insane. Whatever her reason, the police, who were on scene, will more than likely charge her with actual bodily harm (ABH) and she will have a criminal record for the rest of her life. I don’t know if anything or anyone is worth that.

No rest and another call – this time to a train station for a 59 year-old man with chest pain. He was sitting, well slouching badly, on a bench when I saw him. People with chest pain don’t slouch, I can tell you that much for sure and I was unconvinced. However, he claimed to have angina, although he’d forgotten his GTN. He’d been walking around all day with the pain and now it was too much.

I gave him GTN and an aspirin and recorded perfectly normal vital signs. One can ever know for sure, as I’ve said before and he was going to hospital by ambulance BUT when I gave him the GTN spray, he didn’t know what to do with his tongue. If he had his own spray, then surely he’d already taken it more than enough times to know the drill. I had to lift his tongue up for him to administer it. I never have to do that for angina sufferers. Maybe he’d forgotten or maybe he’d never been taught. I gave him the benefit of each doubt.

I got my break after that and watched telly at the station in peace and quiet, which was nice; it felt like being at home, minus the wife and Scruffs of course. But all peace is shattered in time and I was soon off to the next call and it was a genuine emergency.

I was met at the door of the address by a man who told me his neighbour was unresponsive and had been like that for a few hours. I walked in and found him lying in bed, eyes opening to voice but not saying anything back and definitely not 100% there. The call had come in as a '?stroke' but as I started my obs, the neighbour, who checks on his friend regularly, told me he was a diabetic.

‘Oh, I see’, I said. In that instant his demeanour and level of response looked familiar, so I did a quick BM – it was 1.3.

The crew arrived just as I got the reading and we worked together to get the man’s blood glucose up as quickly as possible. I gave him glucose gel but he wasn’t conscious enough to know how to eat it, so I gave him a glucagon injection. We chatted to his neighbour, looked at his medical notes, learned that he was a double-amputee and that his carers had left him like this after attempting to feed him, failing and giving up trying. That’s not something you do with diabetics. Or anyone else you supposedly ‘care’ for.

Over the next twenty minutes he became more alert until he suddenly came on like a light bulb when the glucagon finally kicked in. His BM was improving and by the time we left him, it was a healthy 5.6. There’s no doubt in my mind that his neighbour had saved his life – sometimes just having someone dropping in on you every now and then to check that you are ok is a lifeline. As for the man in the bed; the intransigent Scotsman refused to believe anything was wrong and made it clear he wasn’t going to hospital for man nor beast. So, he didn’t and we left him in the care of his real carer...his friend.

Emotional conflicts and alcohol don’t mix but I expect a grown man to behave with a little more decorum than my next patient, a 25 year-old baby. He collapsed in the street and lay there, surrounded by drunken revellers, refusing to move or respond after his girlfriend dumped him. So the LAS was called in to rescue him from his misery because everyone knows that a Friday night ambulance crew will sympathise with the pseudo-physical nature of a broken heart...especially if it’s compounded by a number of high-strength drinks and a weak disposition.

He lay on the pavement as I attempted to make contact with his brain and he continued to refuse to co-operate when the crew arrived, forcing them to risk their backs and lift him onto the trolley bed. I didn’t expect him to receive a warm welcome at the local hospital.

Towards the tail end of my shift I was sent to an estate for a 30 female with back and chest pain (the chest pain made it a priority call). When I arrived I found the woman writhing on the floor in the hallway of her mum’s flat. Her mother was standing over her and pointed as I came through the doorway. ‘I don’t know what’s wrong with her’, she said. Then she withdrew to a safer distance and I moved into her space to ask the woman what was wrong.

I’ve seen this sort of wriggling, writhing behaviour before and I have to say, at the risk of being accused of professional arrogance, that the ‘patient’ is usually acting up and that there is another reason – a more domestic one – for the behaviour. In this case, however, as time went on and she described the gradual onset of the pain over a few days, during which she tried to cope with it, I became more and more convinced that something wasn’t right with the lady and that her pain was very genuine. She had scored it as 10/10, describing it as ‘sharp’, ‘stabbing’ and starting in her back, radiating through to her chest just below the sternum. She had no DIB and no medical history to explain this. Neither had she suffered any recent trauma.

I'd ruled out pleurisy because her breathing didn't change the pain and there were no other signs to confirm it, so I asked about other things, including her recent C-section birth.

I put her on entonox until the crew arrived and then she was given morphine because there was no way she was going to move from her current position on the floor without screaming out in agony. We gave the drug a few minutes to work and then moved her to the chair. Every now and then she’d cry out in pain as a wave went through her body – the morphine may have taken the edge off it but she was clearly still suffering.

My shift ended with a strange call to a block of flats for a 51 year-old man who was ‘unresponsive’. I was met at the gates by one of his agitated friends and I could see the ambulance coming up the road as I followed him to the flat. Inside there were two more men standing over their friend, who was lying on his back on the floor. He didn’t look well at all; his breathing was shallow and noisy and he looked ashen. It was the look of peri-arrest.

I started checking his vital signs; slow carotid pulse, slow, shallow respirations and completely non-responsive and I asked what had happened. His friends told me that he’d been drinking a lot of whisky tonight but that didn’t convince me and so I looked at his pupils – they were pin-point. ‘Has he taken any drugs tonight?’ I asked. The question is tricky because it makes people react in all sorts of ways – some refuse to answer; some are insulted by the implied accusation and some (usually the guilty ones) will use open terms such as ‘I don’t know’ or ‘I don’t know him/her well enough’. These lads answered with an adamant ‘no’ but changed it to ‘we can’t be sure’ over a period of ten seconds when I asked again.

The crew was now on scene and they started to help me stabilise the man’s airway. His breathing was supported with a bag-valve-mask and narcan was injected into his arm while I got a line in. His breathing didn’t improve much and when I checked his pulse I could feel it slowing down. I re-checked using my probe and it read 38bpm. His sats had been on the floor until he was bagged.

A defib was on him and we were all set for him to suspend at any time the way things were going but a miracle took place (the miracle of narcan as far as I’m concerned) and he suddenly improved, opened his eyes and sat up, startled. Hurrah! He lives.

The man refused to go to hospital and we spent the next half an hour trying to persuade him to do so. He’d denied using any drugs, even though the signs were there. His friends protested his innocence too, citing his fitness and mountain-climbing activities. It’s possible that a ton of whisky had knocked the man out but his rapid recovery was exactly what I would predict after reversing an opioid with narcan, so I left the scene (late again) with a critical mind. Oh, and I removed the cannula from his vein before I went, just in case you were going to write in and be all clever about it.

Be safe.

Tuesday, 11 November 2008

Right and wrong

Day shift: Nine calls; one no-trace; one left on scene; seven by ambulance.

Stats: 1 Malaena; 1 Hypoglycaemic fit; 1 Back pain; 1 Hyperventilation; 1 Mental Health Issues; 1 Haematemesis; 1 Overdose; 1 Cardiac Arrest.

Malaena, for those of you who are new to this blog, is something I find very unpleasant to work with, as do my colleagues. A 40 year-old man waited on a bench at a railway station as police stood over him because he had been ‘pooing blood for days’ as he eloquently put it. He’d been caught trying to steal wine from Marks and Spencer (good quality stuff) and the police were disinclined to take him to the police station, smelling as he was. I don’t blame them.

A MRU colleague was on scene for my next call to a 40 year-old man who collapsed and began fitting in the road. A passing moped rider stopped to help and I found him holding the patient’s head as he came out of it – my colleague was busily trying to establish his baseline obs.

The road was hazardous and just before I pulled up a large lorry turned into the street where the three men were situated, narrowly missing them. So I parked up to block a repeat performance by any other vehicle whose journey was more important than the safety of the patient, crew and helper.

The man became combative when the crew arrived and tried to persuade him to get onto the trolley bed. He was strong and fought us vigorously for almost ten minutes until he’d calmed down enough and recovered sufficiently to realise what was happening. His BM had read low when tested initially, so he needed a sugar boost. I had a small Snickers bar in the car, so I offered this to him and he greedily ate it up. His behaviour was very like a diabetic, except he wasn’t one. Neither was he epileptic, so his seizure was a mystery.

He had sustained a head injury on falling and when a work colleague was contacted, he confirmed that the patient had been in a traffic accident in the near past – he may have suffered a previous head injury and this was now manifesting in fits. He’d have to be thoroughly checked out.

His work colleague was kind enough to attend the scene and talk him into going onto the ambulance, which he’d been unwilling to do for the duration of his recovery. He was eventually walked, at his own request and preference, to the waiting vehicle. His friend travelled with him.

After a quick coffee and chat with my colleagues in the area, I was sent to a Red3, 78 year-old male, DIB, blue around the lips and known cancer patient. It was a good jog away in heavy traffic and I knew the housing estate very well. I arrived to find a man with back pain. No DIB, pink lips and his cancer was under control with treatment. This was a Green call for sure – his back pain was Sacral and non-acute; he’d been getting on with it for weeks and only in the past 24 hours had it become worse. He had no deficit and could easily walk.

The call had been graded Red because the on-call warden had given the description of a dying man to the call-taker in Control. If we’d been busier the cost of a FRU and ambulance would have been deducted from someone in real trouble at that time but there seems to be no way round this problem of panic-stricken descriptions that are sometimes given of perfectly well patients with fairly low-priority problems. It’s easier to judge when you get there I guess but common sense must surely play a part in answering leading questions.

On the Strand a 31 year-old man who’d called us because of blisters on his feet walked into a chemist and told them he had DIB, so another call was made and, of course, the upgrade meant he got an immediate response.

He was hyperventilating slightly and a bit aggressive to me at first. ‘What’s the problem?’ I asked, as I always do.

‘Well I’ve already spent a lot of time telling the ambulance service what’s wrong with me, so that’s a bit of a stupid question, isn’t it?’ was his retort. He clearly wasn’t in a good mood, so I asked him to calm down and explained that I don’t get all the details all the time.

He apologised and we got on okay from that point. Actually, I felt quite sorry for him as he explained that he was new on the streets in London and had travelled from Brighton (it’s a common street person's migratory route) after his family had rejected him (or vice versa) and his wife had left him. He was cold, hungry and thirsty. He wasn’t an alcoholic but in an ironic twist, his thirst was quenched earlier on by another rough sleeper who asked him if he was alright and then gave him two cans of lager because ‘he’d feel better’.

He seemed very distressed about his situation and his need seemed genuine, so as soon as he was taken aboard the ambulance, I arranged for him to be visited by the wonderful London Street Rescue people, who can arrange accommodation and food for him in the short term.

Then I spent a while watching a Big Issue vendor who stands on one leg with his arm outstretched, winks and flashes smiles at passing women, stands to attention for businessmen in suits and generally embraces his lifestyle with as much humility and good humour as possible. I’ve watched his antics before in sun, rain and snow and the guy just never seems to look unhappy with his lot. Unsurprisingly, he makes passers-by smile and he does well enough, from what I witnessed of his sales.

I’d like to take a photo of him and get his name so that I can give him some fame on this blog but I haven’t had the opportunity and I guess I’d better wait until I’m not in uniform. If you are interested in seeing him in action, I’ll do my best to capture him ‘at work’ for you. In the meantime, if you are on The Strand, at the Trafalgar Square end, outside Boots the chemist, then please buy one of his magazines. I saw a laughing couple take several photo’s of him, which he gladly posed for, then walk off, fags in hand, without tipping him a penny…that’s just not cricket, is it? Madonna would charge you at least a quid for the privilege!

Next up, a strange call to a University library for a 70 year-old man who was ‘foaming at the mouth’. Apparently, he’d behaved like this before and had to be chased down the street so that he could be helped, according to the library staff. He is a member and had just gone in to borrow a book when his behaviour changed. I now found him sitting on a chair, surrounded by worried people. He was shaking, clenching and had his eyes closed.

It took a few goes but I managed to get him to stop moving and calm down – sometimes you can see behind the drama, even if you can’t figure out why it’s happening.

When the crew arrived he was a bit less frantic and thus more manageable. He was taken to the ambulance, which had been blocked at the entrance by a plumber’s van (I had to drive around it and onto the kerb to get in).

There was no trace of the supposed headachy, dizzy, chest-pain suffering 32 year-old female who’d called form a phone box and even after checking in at the police station up the road to see if she’d walked in, I had no luck. The police even did a sweep of the area on foot for me. It’s unusual to get hoax calls from females.

I thought the next call had been made from inside a Medical Centre and so I was appalled when the patient, a 20 year-old withdrawing alcoholic, was standing outside waiting for me. He was vomiting blood (Haematemesis) according to the call description and so I thought it was unprofessional of the doctor to send him out to the street to wait. I was wrong, however. The patient had made the call himself from just outside the door.

He wasn’t vomiting blood. The stuff coming from his stomach was white and acrid.

I walked into a bookshop on Piccadilly and instantly recognised it. I hadn’t been in there for over twenty years and now all the memories of having been there came flooding back. I used to manage it when I first came to London. I could have led myself to where my patient sat, huddled in the toilets.

She’d walked in and collapsed and when I arrived the manager came out to meet me. ‘I didn’t know what to do and we have no trained staff here’, she said to me.

I followed her downstairs and found the 22 year-old woman shivering and cowering on the loo. She had told the staff nothing of her problem but had simply said ‘I feel horrible’. They had called an ambulance on the basis of her ‘DIB’, which didn’t exist.

I asked her three times what was wrong until she confessed that she’d taken an overdose of paracetamol. She hadn’t actually taken enough to cause Liver damage but she had attempted suicide and that was worrying enough. She was very distressed and I kept her calm and walked her out of the shop to the arriving ambulance.

The crew took over once I’d established her obs were ok and she was taken to hospital. Hopefully, her problems will be discussed and she’ll get the help she needs to prevent another attempt.

My last call of the shift came as I was winding down to go home. I was sent to an 89 year-old cancer patient who was ‘semi-conscious with shallow breathing’. This was ominous and I knew it could change at any time.

As I reached the street, the call became a Red1 and changed to cardiac arrest. I rushed in as the ambulance arrived at the end of the road. I was met at the door of the flat by the patient’s son; he was weeping and frantic. ‘He’s dead, isn’t he?’ he sobbed.

The man lay on his bed and I approached and checked his vitals – there were no signs of life. The son had been carrying out CPR under instruction and the man had stopped breathing only a few minutes ago, so I was left with a very difficult decision to make and one that I later agonised over for days afterwards. Do I continue the resuscitation attempt and thus try to save his father, even if it’s for a short time, or do I simply tell him there’s nothing more I can do? The son’s emotional state was confusing because it wasn’t clear which he’d prefer – did he want his father left in peace or did he want something done?

I decided that, as the crew were on scene and the attempt had been started, it would be better to try. So, we moved him to the floor and spent the next sixteen minutes working on him with no change in his condition whatsoever. I communicated with the son, who insisted on staying in the room throughout and made it clear to him that we would stop after a certain time unless he absolutely did not want us to continue.

I have no idea why I felt so bad about this job when it was finished. I think I felt guilt at the emotion I had put the son through by having him witness such a horribly traumatic event (CPR is a messy, noisy and emotionally painful business). I could have decided not to start because the man had a terminal illness, thus he could have been left in peace on the bed but I felt strongly that the son would have seen that as inaction on my part and I know that I would be bitter about such reticence if it was my loved one. I felt it was better to try and fail than not try at all.

I called it after sixteen minutes because I know the son had seen enough and there was no hope. We wrapped the man up and laid him back in the bed. Even though the son thanked me for trying, I felt I’d let him down horribly for continuing the attempt that he’d started and of all the cardiac arrests that I’ve called over the years, I felt more depressed about this one than any other – I knew it was illogical but I couldn’t help going home with a black cloud over my heart.

Be safe.

Sunday, 9 November 2008

Blame culture

This lady is ‘considering suing her son’s school’ for ‘failing to exercise their duty of care’ when he fell in the playground, bumped his head and subsequently – hours later – developed neurological problems, as the result of an intracranial bleed.

I train at many schools around the country - I teach the staff basic first aid and that's all they need to know. I also tell them some home truths about their position and what their actual duty of care is when it concerns children and accidents.

I feel very angry when people try to use their limited or flawed knowledge of the law to persecute for the sake of blaming someone for things that could NOT have been foreseen. Instead, these same individuals complain when their life is interrupted in the interest of the self-preservation of others. For example, school staff. They are an easy target, aren't they? Let's all blame the people with whom we trust the care and education of our children. Let's give them such a hard time that they are drained of power and no longer care whether their job is valued by us or not. Many of them leave the profession, rather than spend another minute listening to the constant whining, bitching and bossing of parents, some of whom are ignorant and unreasonable. Start taking responsibility for your own kids for Pete's sake!

Would it be reasonable for a school to call you every time your child fell? No. You'd have a go at them for that too.

I am a parent, so I have the right to speak about these things. I am a professional clinician, so I have the right to defend the principles upon which these words are based. I know the law and therefore I can categorically state in fact what would be right or wrong in some, but not all, cases where first aid care is concerned. I am also a member of society and was brought up to respect my teachers and all the adults working in schools. I had a healthy fear of the consequences of my actions and my parents were guided by the better judgment, in most cases, of the professionals they had put their trust in.

Now, here's the problem at schools. This case, sad as it is for the unfortunate little boy and his mother, will cause repercussions throughout the country and every nervous school will call an ambulance EVERY time a child falls and bumps his head! This is intolerable. We have all bumped our heads. Every now and again, just like in adult life, a complication occurs...sometimes people die. We can't scan every head that meets a pavement or a classroom floor.

Now who is to blame for this boy's injury? Did a teacher throw the child to the floor? Was he pushed, shoved or tripped by someone or something? Probably not. He fell by all accounts. The school staff monitored him and did exactly what they were supposed to do. What they did NOT do was dial 999 and say 'We need an ambulance for a....err...well, a child who has fallen'.

'What injuries does he have?' they would have been asked.

'Well, none that we can see'.

'Is he conscious?'


'Is he breathing?'


'Is he vomiting?'


'So, you want an emergency ambulance for an uninjured, conscious child, who is breathing and behaving normally?'

'Yes because if we don't the parents might sue us.'

'Okay but have you considered who may die of a heart attack because our ambulance is travelling to your school for nothing at all?'

In the end you have to ask yourself a perfectly logical question. Do you have any reason to send this child to hospital, other than an irrational fear that something untoward may have taken place inside his skull that you cannot see?

What if this had happened at home? Is this lady honestly saying she would have rushed him to hospital or called an ambulance because he fell and hit his head? Has he never hit his head before?

What kind of person tries to blame a school for such an unfortunate accident? A scared person? An ignorant person? A embittered person who needs to express her anger at God?

I will apologise for all these words if it transpires the child was abused in some way or there was a hazard in the school environment that caused the fall but I protest at society and it's need to hound people who care for our kids whenever it suits them. Pursue them for a reason, don't bully them just because it's easy and you feel guilty that you weren't there.

Why not sue the school for having a hard floor in the first place? Why don't we start fitting rubber flooring everywhere? While we are at it, let's ban rain because it makes the outside ground slippery and a child could fall.

When I teach, I rarely get a negative reaction to my views and generally the vast majority of people in front of me will nod their heads in agreement and debates will begin on the spot. Nothing changes though and I blame the parents for that. It's time parents got together with their schools and talked these issues through. Let's look at some of the other examples of an automatised blame culture society that seeks to justify it clingy cotton-wooled sentiments over health and safety.

Plasters; you are not allowed to put one on a child because he may react to it. RUBBISH! Even the HSE has produced a poster informing everyone that this is untrue. In fact, not putting a plaster on could be seen as neglect because it is a first aid 'tool' and an alternative may not be sterile and could cause infection. I've seen filthy toilet paper put on a wound instead of a plaster because of this stupidity.

Splinters; taking one out of a child's finger is illegal and is assault. ROT! It is NOT illegal to do the duty of a parent when you are in charge of their child. By proxy you 'become their parent' - In loco parentis - a legal term which literally means 'in the place of a parent'. So, legally, a teacher/school must show the same duty of care towards a pupil as would a reasonable parent. In other words, if you think a mother would remove a splinter, then you should remove it. Why on earth, unless there are complications, would you send your child to hospital with a microscopic bit of wood in his finger? Are you mad?

Inhalers; you can keep a spare inhaler and use it when a child has forgotten to bring theirs to school. NO, you can't...not unless it belongs to the child himself. It is illegal to use someone else's prescription medicine in any circumstance, unless it is on the exempt list (epipens are on this list). I know of at least one local authority that actually sanctions and authorises (as if they have the right) the use of anyone's inhaler in cases of emergency. In a real emergency it probably won't be effective and giving a drug that you know nothing about and does not belong to the recipient is negligent. By all means store a spare belonging to the child, and then only in term time.

Or how about this? Let the child take care of his/her own medicines. If they are deemed to have capacity, they can keep their own.

I could go on and on...the list seems endless and the capacity for parents to make life miserable for school staff seems inexhaustible. I feel very sorry for them.

Have a look at the other myths being circulated as truths on the HSE's own website.

And for the record, here are some extracts of relevance from the Government's guildelines on medicines in schools. The government also makes it clear that there is no legal responsibility for school staff to administer first aid to pupils but there is a duty of care.

13. Parents have the prime responsibility for their child’s health and should provide schools and settings with information about their child’s medical condition.

16. There is no legal duty that requires school or setting staff to administer medicines.

25. Medicines should only be taken to school or settings when essential; that is where it would be detrimental to a child’s health if the medicine were not administered during the school or setting ‘day’. Schools and settings should only accept medicines that have been prescribed by a doctor, dentist, nurse prescriber or pharmacist prescriber.

34. Misuse of a controlled drug, such as passing it to another child for use, is an offence.

89. Teachers’ conditions of employment do not include giving or supervising a pupil taking medicines.

107. Large volumes of medicines should not be stored. Staff should only store, supervise and administer medicine that has been prescribed for an individual child.

108. Children should know where their own medicines are stored and who holds the key.
The head is responsible for making sure that medicines are stored safely. All emergency medicines, such as asthma inhalers and adrenaline pens, should be readily available to children and should not be locked away.

If you are a teacher or work at a school, you may find some of this information interesting, especially if it comes as a shock to you. In my experience, not many schools have seen or even know about the Government's guidelines on first aid and medicines policy in schools.

I'd like to know your views on this but please don't bombard me with stories that simply highlight rare and unusual circumstances because that's just missing the point.