Wednesday, 31 December 2008


Day shift: Five calls; all by ambulance.

Stats: 1 High temperature; 1 Abdo pain; 1 Head injury; 1 RTC with ? injuries; 1 Collapse ? cause.

A mum and baby were ill somewhere in the north and I was sent to check them out. Two ambulances were already in the same street attending to someone else when I arrived and a vehicle was parked outside the address I was going into. The crew was inside the flat dealing with a mum who complained of ‘pain all over’ and a baby with a high temperature (30c). The baby needed to go to hospital without a doubt; the mother didn’t seem to have anything wrong with her except lethargy.

And a 34 year-old woman told us she had chest pain and DIB but didn’t. She had abdominal pain which she’d suffered for three days. She didn’t call her G.P. and thought an ambulance would be more suitable.

On Oxford Street I raced to an 18 year-old boy who’d walked into a lamp post and collapsed. When I got on scene his father came up to the car and said ‘don’t worry, take your time…it’s not an emergency’. So just to make sure we’d ‘dotted our I’s’, the MRU arrived on lights and sirens. HEMS wasn’t coming thankfully.

The Australian lad had simply walked into a post when he wasn’t looking (probably distracted by all the sights of Oxford Street…and the shops). He’d smacked his head hard, wobbled a bit then collapsed in the street for a few seconds. I found him sitting at a table outside a cafĂ© looking none the worse for wear except for a tiny cut above his eye.

My MRU colleague left when it became clear he was redundant and the ambulance appeared a few minutes after I’d settled the young man into the back seat of the car for obs as his father and brother waited outside. His trip to hospital may be less of a story to tell back home than his experience with the rapid and somewhat overwhelming emergency response he got in Central London. Still, we try to please…

When cars hit people we expect an injury or two but the RTC I was called to – one that caused a fair amount of traffic chaos – was a non-runner for me as the patient seemed to be completely unhurt. A crew was on scene and after a cursory check that I wasn’t required (I wasn’t) I left them to it.

One of those infamous Red1 calls for ‘life status questionable’ but for a completely understandable reason…and one I think we could probably go some way to resolving. The caller didn’t speak any English, so when he was asked about breathing and the condition of the patient (a man who’d simply fallen down) he couldn’t answer. For that reason the big panic buttons were pressed because there is no other option – if the question cannot be answered in the affirmative then it is deemed to be negative. So, he might not be breathing; therefore Red1. When I got there the crew was chatting to the supposed non-breathing man and me and my MRU colleague (who’d arrived just ahead of me) left the scene.

Here’s my solution to this problem. We should hire a multi-lingual person and put them on a desk in Control. They needn’t be clinical, all they’d do is speak to non-English speaking callers and translate so that the patient-picture is clear and the response is appropriate. This person would only have to speak a few specific languages that are relevant to the diverse population of London and the highest statistical sample that we are likely to receive calls from. I know of at least one person on staff who already speaks up to ten languages fluently…why don’t we give him a job reducing unnecessary priority calls?

Okay, in reality I don’t know how many language-barrier type calls we receive that ultimately trigger ‘Category A’ responses but I’m willing to bet there are enough to justify a useful tool for reducing them. Just a thought.

Be safe.

Tuesday, 30 December 2008

Booze Bus to the rescue

Night shift: Nine calls; One assisted-only; the others by ambulance.

Stats: 2 Faint; 5 eTOH (3 in one call); 1 Palpitations; 1 RTC with head injury; 1 Head injury.

A 20 year-old female said to be unconscious in a shop turned out to be a ‘floppy doll’, neither walking nor talking properly despite having little or nothing wrong with her. She may have had a faint but that’s questionable since nobody actually witnessed it and she appeared to be fully conscious. A three man crew (you’ll see a lot of them now because we have a high number of trainees out and about) was on scene and it took a while for us to locate her but when we did she looked more unhappy about being at work than any existing medical problem.

Red1’s for ‘ineffective breathing’ are abused regularly and this call was no different. A drunken East European man who wouldn’t stand up and kept repeating ‘I no understand’ literally jumped aboard the ambulance when it arrived. I was surprised he hadn’t claimed epilepsy as his problem this time round.

Palpitations in a person with known heart problems are to be taken seriously but my next patient walked down stairs with her elderly friend because she knew it was a hard climb for us. Bless.

The 71 year-old looked fine, if a little out of breath and the ambulance pulled up just as I was sitting her down for a rest in the car.

I was directed to a top floor (where else?) flat by a neighbour when I pulled up on the next call for a 41 year-old man with a head injury, caused, according to the man shouting at me from the balcony of his flat across the road, by a fall. The helpful caller had taken the man up to his flat and then gone home to watch as I arrived. He stood on his balcony and bellowed out instructions on how to get to the patient.

The injured man was sitting in a corner inside a grotty unkempt kitchen (in a grotty unkempt flat). The door was ajar and I walked in to find him slumped there with a very nasty bulge on his head. The injury looked old but dangerous and he confirmed that he’d just come out of hospital after discharging himself before anyone had taken a good look at it. He may well have fractured his skull but he was too drunk to bother about it.

When the crew arrived they took the same breath in that I had initially – not because of the filthy state of the place but because of the man’s head. We carefully took him back to hospital and delivered him to Resus where, hopefully, he’ll stay put.

‘How did you get here from the hospital?’ I asked him.

‘I walked’ he said, matter-of-factly.

He’d managed to walk two miles without anyone, except the neighbour across the road, seeing him or calling an ambulance. I found that strange because we get calls all the time from worried MOPs when they see much, much less.

A 25 year-old woman who was said to be vomiting blood was expelling nothing more than the Soy sauce from her recent Chinese dinner. One of the people with her told me that he was a surgical nurse and that what lay in the little sink in the toilets where they had gathered was ‘definitely frank blood’. It definitely wasn’t and I touched it with my gloved hand, rubbed it across one finger to prove that fact. It even smelled like Soy!

Three for the price of one next at Piccadilly Circus. Two drunken girls, an unconscious drunken man and a crying woman (bonus person) were all I had to contend with for this emergency call. They were swept up and taken away one by one, courtesy of the booze bus. To be fair, the drunken man, who lay a few metres away from the first drunken girl, looked like he may have had a fit of some kind but he recovered miraculously in the back of the ambulance. Thank God for the booze bus - I’d have been there all night if it hadn’t been doing the rounds.

A taxi hit a drunken man as he crossed the road and he lay on the tarmac with no injuries that we could see. Nevertheless, he was knocked out for a few seconds so he was collared and scooped up by the crew. The taxi suffered a broken mirror and the poor cabbie had to wait, passenger on board, until the police arrived some twenty minutes later. I hope his meter wasn’t still running.

A 19 year-old female fainted in her hostel but was recovered by the time I got there. Her obs were normal but she wanted to go to hospital and the crew obliged.

Someone else who was said to be vomiting blood and wasn’t; the patient on my last call had stomach ache and nothing more.

Be safe.

Sunday, 28 December 2008

The 999 Virus

Night shift: Ten calls; One assisted-only; one taken by car and the rest went by ambulance.

Stats: 1 Allergic reaction; 2 Faint; 1 ?EP fit; 1 In labour; 1 Chest pain (non-cardiac); 1 Dislocated shoulder; 1 Viral tonsillitis.

It’s unusual for babies to be vomiting blood, so when this call came in for a 13 month-old who was allegedly doing that I was a little sceptical. The parents were anxious because they were sure they’d seen blood and told me that the little girl may have eaten a bit of one of the pine cones from the Christmas tree. She had recently suffered Croup and, although her breathing was fine and there was no evidence of bleeding from anywhere, it was wise to have her checked out in case there was a re-occurrence of the virus.

I assisted the MRU paramedic with the next call for a 60 year-old who’d fainted in a crowded bar. He was stable and the paramedic had everything in hand, so I fetched and carried for a few minutes until I was made redundant by the ambulance crew.

My next faint was for an 82 year-old lady who’d passed out in church. Again, there wasn’t much for me to do because she was fully recovered when I arrived and all that was needed was a couple of sets of obs. She declined to go to hospital and so was left in the care of the church staff.

I nearly broke my neck on the grease-covered floor of a Chinese restaurant’s basement kitchen as I attempted to reach a 66 year-old man who was currently in the toilet throwing up. He’d arrived for work looking very pale and unwell. The normally fit and well man took his time in the loo while I stood outside and waited for him. By the time he was out the crew had arrived and I had assumed nothing about him without a single measurable observation.

An amber call for an epileptic who was ‘no longer fitting and breathing normally’ meant I didn’t have to risk as much in the traffic as I made my way there but when I walked into the McDonald’s restaurant I saw that the 29 year-old female was on the floor – still in seizure. She’d been like that for twenty minutes, according to her boyfriend. I tried to keep her head protected as she flailed and bashed around the counter area but she was on a mission and I could see something was amiss. Customers continued to queue for their burgers as I attempted to reason with her but she was determined to continue what I firmly believed was a charade for some time. Her legs were dancing but the upper part of her body was toned and controlled, something you don’t see in epilepsy where uncoordinated muscular twitching is the general rule ( in doesn't always apply, I know).

When the crew arrived she was given diazepam just in case I was wrong but when she went to hospital the Resus team thought the same and the doctor wasn’t convinced by her acting either. I have seen a lot of this kind of behaviour; the usual mixture is alcohol, a history of depression and the Festive season…for some reason that combination produces bizarre pseudo behaviour, especially in the female of the species. Sorry if that’s sexist to you but I’ve only seen this in women. If it’s an attention-seeking device it certainly works…until people who know epilepsy turn up. As for the diazepam, I’m duty bound to treat what I see, regardless of my opinion.

Just before I left hospital, she threw herself dramatically onto the floor of Resus and continued the display. The doctor rolled a screen around her and she was left there until she came to her senses. I heard later that she stormed out in a huff (the patient, not the doctor).

A young mother-to-be panicked when her waters broke and she flooded the bedroom, so her husband called an ambulance. Her contractions hadn’t yet started and she was perfectly calm now that a yellow jacket was on scene. Her husband had packed everything in readiness and off they went to maternity for a delivery that might take hours or seconds. This lady needed special care because she had two mechanical valves fitted to her heart and was on ‘blood-thinning’ drugs.

I was in poshville for the next call. I don’t often get sent to well-off people’s houses; they just don’t seem to need us much. The house owners didn’t have a medical emergency themselves but their 27 year-old live-in nanny apparently did and it was her I saw leaning over the toilet vomiting. She was pale, shaky and very unwell. She had rib pain which was flaring up again tonight after she’d completed a course of antibiotics for inflammation diagnosed earlier in the month. Of course it was given as chest pain and technically that can’t be faulted but a few specifics would have sorted the wheat from the chaff.

A fight in the West End created a short moment of havoc for the police and the booze bus, the crew of which was on scene before I arrived. It wasn’t a call for me; I was just visiting but while I was there a police officer asked me to look at a young man’s shoulder. The cursing 22 year-old had attempted to punch someone during the fracas and missed. He had swung his fist so hard that the energy used and not transferred to a face or body had simply resulted in his shoulder joint coming apart. He was in a great deal of pain and swore through it like a trooper – I prefer quiet moaning myself.

The cop on duty was my big Scottish friend from Soho and once again he handled the young man’s behaviour with calm reason – it would have been so easy to get annoyed with him but then the pain of a dislocated shoulder can’t be underestimated.

I put him on entonox and enquired about an ambulance – silly me. I waited and waited then took an executive decision…I would drive him to hospital myself. The police officer came along too, informing me in a quiet whisper that the patient was probably going to be arrested at some point anyway – it just wasn’t his night.

At hospital several attempts were made to pull his joint back into place (you don’t want to know the details) but they failed. A loud click signalled misery for him as the ball at the end of his Humerus refused to align itself with the socket and simply slipped out again and again. He was too tense, the doctor decided, so he’d need a muscle relaxant. IV pain relief was problematic because the man was so drunk. So, I left him in the care of the doctor and nurses who prepared yet again to rein in his loose limb with brute force. The patient lay back and joked, swore and cried out intermittently. He was, in the end, good humoured about it all but then if you are going to miss a punch so badly, humour is all you have left.

I left the crew to search for the 26 year-old student who was apparently coughing up blood and unwilling to give an accurate room number for his address at a Halls of Residence building. I had already waited ten minutes to be shown where he was – just as well I got there within the Government target.

My last ‘DIB’ call in the early hours of the morning led me south for a woman at a hotel who had viral tonsillitis. My years of treating hundreds of children with sore throats on summer camps have given me enough experience to recognise it immediately. She was breathing just fine but her swallowing was difficult and she felt unwell. An ambulance arrived for her but she really needed to join the big worldwide club of people who tend to these things themselves. If this kind of behaviour continues REAP 4 will become our standard operating level.

Be safe.

Wednesday, 24 December 2008

Happy Christmas

I've got a few more posts to catch up on...I've been working hard and haven't had the time to write them up yet but I will. Also, my apologies for not replying to comments for a long time but, again I haven't really had the time. I rely on those of you who do it on my behalf and I'm very grateful to you for it.

Merry Christmas - I hope you all have a decent one, especially in these gloomy economic times. Thank you all for reading the blog and buying the book. Thanks for the hundreds of emails and comments that I have received...mostly positive.

When I started writing this I was easily bothered by those who spent their time trashing whatever I said but now I know it's impossible to please everyone, regardless of the time and great care I take when I compose each post. I have considered quitting from time to time as it seems to be a lot of effort for the time I have available BUT I have thousands of loyal readers and that has kept me going. Now I write knowing that the best I can do is inform and perhaps inspire - what I don't do is please everyone.

So another year marches in and I'm ready for it. I won't finish the next book til near the end of 2009 I expect but I'll do my best. I have other responsibilities and have progressed in my job so I have even less time to spare but I love writing and will plough through it until its done.

Take care all and have a good one!

Xf (Stuart)

Wednesday, 17 December 2008

Fatal judgment

Night shift: Eight calls; one assisted-only, one declined, one dead at scene and the rest by ambulance.

Stats: 3 eTOH; 1 Hyperglycaemia; 1 EP fit; 1 Fall ? #; 2 Head injuries (on one call); 1 Faint with head injury; 1 Purple.

As I said, this is the time of year for the stupidest people to do the dumbest things...sometimes with fatal consequences.

My VDI delayed the response to my first call of the night; a 25 diabetic who was hyperglycaemic. By the time I arrived a crew was turning up – they’d been run from the north for almost three miles to help out. The patient wasn’t critical and could have waited longer...or gone by bus.

An epileptic 28 year-old man walked to the ambulance unassisted when he was brought out of an underground station by the crew. I’d driven a long way to get to this 'emergency' and the ambulance had reached him a few minutes before I got on scene. I wasn’t required and it looked like the patient had made a full recovery.

A 68 year-old drunken man fell and smashed his face on the ground. Witnesses say he was knocked out. His cheek was badly bruised and swollen and when I examined the inside of his mouth I could see the zygoma (cheek bone) protruding into it. I guessed it was broken on that basis. First aid had been rendered by MOPs who were waiting for my arrival, so the bleeding had been controlled.

The man was very well-spoken; posh in fact. He told me he was a writer and when I asked about the old scars on his wrists he became very defensive and refused to talk about them...fair enough.

He and his shopping were loaded onto the ambulance fifteen minutes after I met him.

An assault call to Regent Street next. Two males alleged they had been attacked by a gang of youths who jumped out of a car. They were both beaten up in the street. Both men had fairly minor injuries – both had been hit around the head. One of them had a more significant injury than the other – he was the one lying on the ground with the crew standing over him when I arrived. Police had cordoned off the scene, including the road itself, which caused havoc with traffic.

The young men were mouthy and drunk. The police had no doubt that they were somehow involved in starting the fight and so everything they said was listened to critically. The man who’d been on the ground asked if his injury was ‘a good one’ as he sat in the ambulance. He was obviously more concerned about the battle scar he might be left with in terms of pride than worry.

Off to an art gallery on my next call and I was dealing with a 44 year-old woman who’d fainted while coming down the stairs. Her fall produced a minor head injury – a laceration to the crown of her scalp. She’d need to go to hospital and get it glued shut but otherwise she was fine.

I got back to the station for a rest and waited five minutes before getting a request to travel four miles to an area I didn’t know for a stomach ache. By the time I’d reached the main road into the area ORCON was out the window and I was stopped in my tracks by a police van blocking the way. An incident had taken place further down the road and no traffic was being allowed in. I called Control and let them know that my journey had come to an end. I was cancelled and turned tail to get back to the station.

Then a 2am call came in for an 18 year-old who’d fallen thirteen floors after an argument with his mother. The job was miles away but I headed down at speed, fully expecting to be cancelled for one of two reasons – I was probably further away than another resource that would get there earlier and the boy was likely to be dead. I was correct on one count.

When I arrived the police were on scene in numbers and a crew had pulled up a minute or so before I got there. I could see the ambulance inside a small courtyard below a very tall block of flats. It was eerily quiet as I approached the figures standing around the crew. The paramedic was holding a BVM (bag-valve-mask) and the technician was preparing equipment. The FR2 defibrillator was on but there was nothing happening with urgency. They were looking down at the body of a young man - he lay like a starfish, arms outstretched, on the concrete. Blood had gathered in a think dark pool under his head. His eyes were shut and he was very still.

‘He’s got massive head and chest injuries’ the paramedic told me.

Not much else was said. He’d come down over a hundred and fifty feet. There was no chance of recovering him – his injuries were incompatible with life and his ECG continuously flat. We all agreed to call it before we started.

The story of how this teenager ended up dead on the ground is quite shocking. The ambulance paramedic and I headed up to the flat where he lived and found it full of quiet people. The mother, two teenage girls and another female friend were there with four or five police officers. There was only one person crying – one of the teenage girls. The mother started shouting and cursing the boy who lay a long way below. It was surreal; nobody seemed to be truly affected by what had happened.

After a short time in the flat the events of what happened unfolded and then my colleague and I realised something was amiss.

The boy had argued with his mother about a trivial matter. He had a habit of climbing over the balcony of the flat and standing on a thin ledge on the other side, holding onto the balcony itself. From there he would threaten to jump. It was emotional nonsense and he never carried out his threat, so when he did it again tonight, nobody in the flat took him seriously.

His fatal mistake was to hold onto the Christmas lights that were wound round the balcony on the outside. He used the tubular light strip for support but it came away in his hands and he simply slipped down it, like he’d grabbed a greasy rope. I looked over the balcony and the light strip was waving about in the wind, flashing happily away. Far below it was the body of the boy who’d used it to threaten his loved ones.

When he fell only one person saw it – one of the girls. She sent his friend downstairs to ‘see if he was alright’. His friend had found the body, called an ambulance then sat in a corner crying. That’s where he was when I arrived. A police officer had wrapped a blanket around him and was trying to reassure him.

My colleague and I realised within a short time that the family hadn’t been told he was dead. They actually believed we were ‘working on him’ and that he was going to be okay. One of the officers broke the news and the noise level changed immediately from subdued and angry to screams and cries of horror and shock.

I left the scene with a heavy heart. I couldn’t explain to myself the motive to be found in a person stupid enough to throw away such a short life in such a bizarrely careless way. The debt of grief left behind will never be repaid. I drove off and looked at the building as it appeared in my rear-view mirror. The Christmas lights were still busily flashing their ‘peace and joy’ message from the 13th floor.

A stupid person lay on the pavement near Trafalgar Square. He didn’t move, so a MOP called an ambulance for him. ‘What are you doing lying on the pavement?’ I asked him when I arrived. ‘Making it look good’, he replied with a silly, drunken grin.

I got him up and into the ambulance when it arrived but as I sat in my car completing the paperwork for this call, he jumped out of the side door, slammed it hard and stormed off, middle finger in the air shouting ‘F**k them!’ Clearly he hadn’t warmed to the crew for some reason.

My last call of the night angered me because it was a typical imported fraud. An East European man lay inside a public toilet – one of those automatic things. An engineer found him and another man sitting there when he opened it to carry out routine maintenance but the other man scarpered, leaving one on the floor. Instead of leaving when requested, he decided to feign illness and the engineer had no choice but to call an ambulance.

I got there and looked inside. The man was curled up on the floor. ‘What’s wrong with you?’ I asked. ‘Epilepsy’ he bleated.

This was rubbish. There was no sign of him having had a fit and the engineer told me that he hadn’t done anything untoward since being discovered. The man wanted a hospital bed and that was that.

When the crew arrived we persuaded him to leave the toilet or the police would be called. Once he knew the game was up, he stood up, ranted a bit, stomped off and threw bins and property around the street in a demonstration of his contempt for us. Is that really the type of person we want wandering our streets?

After tonight I know there’s more to come.

Be safe.

Tuesday, 16 December 2008

REAP the harvest

You'll see this giant inflated monstrosity in Carnaby street. No wonder some people get depressed at this time of year.

Night shift: Thirteen calls; two assisted-only, one false alarm, one taken in the car, nine by ambulance.

Stats: 4 eTOH; 1 EP fit; 1 RTC with serious head injury; 1 Bleeding PR; 1 Asthma; 1 Overdose; 1 Assault with facial injuries; 1 Chest pain; 1 Head injury.

We have a grading system to help us cope with the pressures of dealing with the changing weather of emergency response. Its called REAP (Resourcing Escalatory Action Plan) and its lowest grading is 1; the highest is 5. When we reach REAP5, we’re in trouble and the entire system could fail. This would only happen if multiple major incidents occurred at the same time and we became seriously stretched. Of course we’ve been near to it – terrorism, train crashes and natural disasters all contribute to an unforeseen peak in resource and manpower requirements.

Tonight I started the first of three night shifts. It’s the run up to Christmas and it’s a time of joy, faith, love, family…drunkenness, violence, depression and suicide. We are at REAP level 4. Thank God its Christmas.

Amazingly I am beginning to hear words from drunken lips that I haven’t heard before. My first patient was sitting outside a pub with her boyfriend. The 22 year-old was very, very drunk and taking anti-depressants, a cool combo I think (not). The first thing she said to me, through those particularly specific type of tears (person with issues) was ‘I’m really sorry. I don’t want to be a statistic’.

I took her and her boyfriend to hospital in the car. It seemed a shame to waste a perfectly good ambulance on her. She became a statistic by default.

I only mention this because she wasn’t the first person to express embarrassment in the knowledge that, yes, our time was being wasted on something that wasn’t really medical. Airing my opinion on this matter isn’t hot-headed and it isn’t about my arrogance or self-glory, I assure you. Its about the people I see in the course of my duties; the other crews, the doctors and nursing staff, the genuinely ill people who can’t get a bed in A&E because some drunken, drugged-up waste of space is doing what they do best…wasting space.

Maybe the news stories about inebriated Britain are finally getting through. Maybe.

To prove my point and to clarify that not all time-wasting calls are booze-fuelled, I was cancelled on the way to a call I queried with Control before I set off. It was for a baby who had a rash on his behind and who was crying. The rash developed just after a nappy had been removed. Now, in my world, which some may think is small and concrete, this is called nappy rash. Hands up if you are a parent who has seen this? Keep your hands up if you dialled 999 in a frenzy of panic when you did? I was cancelled but an ambulance was still sent and because the crew may well have decided not to risk criticism from the parents, the baby would probably have been taken to hospital where the staff would spend tax-money hours telling the parents to grow up.

A call to a bus for a 48 year-old woman who fitted for a couple of minutes next. Two passengers were helping her out when I arrived. She was post ictal and confused about where she was but she seemed to understand that she’d had a seizure. Two ambulances showed up for this call for some reason but I only needed one.

Then things got serious. I was three minutes from a RTC in which an elderly man had been hit by a car. The details included ‘blood coming from nose’ and ‘hit windscreen hard’, so I knew I wasn’t going to a walking, talking patient. In fact, when I got on scene, an ambulance was already there and one of the crew was standing over the body of a man in the middle of the road. The area was becoming crowded with MOPs and the police had yet to appear. A few TA soldiers were helping out and they became extremely valuable to me and my colleagues over the next thirty minutes.

On the way to it, I passed the HEMS car and a message flashed on my screen to radio in a report for them. I wanted to slow down and wave them in my direction because sometimes you just know they’ll be needed but I didn’t. Luckily they decided to make their own way.

The crew had stopped with a patient on board; they’d been flagged down on their way to hospital with a recovering epileptic in the back. The paramedic who was driving got out to render aid while the attendant stayed in the back with his patient.

The man in the road wasn’t moving and was breathing noisily. He had blood oozing from his mouth and nose. He wasn’t conscious and it was clear he had a serious neurological problem.

HEMS arrived as I called in my report and the cops were on scene at the same time. A scene like that changes from subdued chaos to organised rescue in seconds when the right personnel arrive. Everyone knew their respective roles and before too long the man was on a trolley bed, RSI’d and stabilised for his trip to hospital. His clothes were on the road – a small pile of personal history. His blood also remained on the road. His chances aren’t good but we all hope he’s stronger than we think.

The 20 year-old ‘unconscious’ girl walked out with the underground staff she had caused to call 999. She was, inevitably, drunk and stupid. ‘I don’t want an ambulance, I want to go home’. I agreed with her, even when she vomited a little on the pavement for the benefit of the public. I tried to flag down at least three taxis but none of them were interested, strangely enough. If only she’d stop vomiting and look half-sober, then she’d be be able to get a cab. Standing in the road in this uniform, waving at taxis is a sure-fire way of putting them off. It means ‘I have a drunk for you – he/she/it may vomit all over your nice clean place of work but, hey, I get that all the time, so come on, be nice’.

In the end I left her with the underground staff – they’d started it after all.

I’ve never visited a lap-dancing club (or table/pole dancing…or are they different?) so I was mildly amused to find myself wandering through one with the manager as scantily-clad young women passed by (and ignored me). I was there to see the chef – he’d been passing blood PR and this wasn’t the first time either. The last time it happened he became unconscious and spent days in hospital. The 53 year-old was waiting for his test results but the pattern didn’t look good.

The crew arrived – one with a very smiley face and one who didn’t care either way about the half-naked women because he had no interest in that gender – and they thought the same as me…the guy didn’t look very ill. In fact, he virtually ran out to the ambulance. I was to learn later that the reason for that was that he needed to open his bowels, which he did at hospital. He passed a lot of frank blood by all accounts.

I reached the address of an asthmatic who was having an attack but the crew was on scene, so I turned my tail and left.

I drove at speed a long way to the south for a stab victim to find the police on scene with a homeless drunk who had defecated in his trousers. He knew an ambulance wouldn’t come for that, so he made the whole ‘I’ve been stabbed’ story up for a higher quality response. Utter nonsense. Two police vehicles, an ambulance and me…all for a man with no sense of dignity or pride – neither attribute a medical emergency.

I went even further south for another drunken man who sat in a doorway, metres from the local A&E department from which he’d voluntarily walked out (he still had the hospital gown on). He had a sliced open thumb which was either caused by a fall or was self-inflicted. He was too drunk to care either way and seemed eager to get back on an ambulance for the world’s shortest trip to hospital. It was a ridiculous situation.

The second embarrassed apology came from the lips of a woman who ‘didn’t know what else to do’ when her husband started vomiting after drinking too much. The call was given as DIB incidentally, ensuring a Red response at a time when we are coping with almost 4,500 calls a day. The fact is he was hyperventilating – this happens when you vomit. It took twenty minutes for me and the crew to persuade him to control himself and live with the consequences of alcohol, as we all must if we wish to drink it in excess.

In Soho I met a police officer that I’d work with every night of this tour of duty. He is a tall Scottish man and he has the most patient, caring attitude to people I have seen in a while. He was propping up a 33 year-old man who’d overdosed on cocaine, GHB and very possibly something else. He had pin-point pupils, so I gave him a couple of doses of Narcan as I waited for the ambulance. Meanwhile, a few of the more nauseating people on scene became a problem for me – pushing me, butting in and causing trouble. This prompted one of the other officers on scene to shout at one man in particular – in fact, he swore at him to make his point. For the first time in my career I didn’t find that shocking or unprofessional in the least. Under the pressure they are constantly subjected to, it’s no wonder they keep as calm as they do half the time.

The young man was in a bad way and didn’t fully regain consciousness when the crew took over and further doses of Narcan were given.

A call to a narrow road near Carnaby Street for a 35 year-old male who was lying on the pavement next and the cops were on scene ahead of me, searching for him. It wasn’t until we ventured further up the road that we saw him. He had a facial injury – a possible broken nose – and his trousers were down around his hips. All the personal stuff from his pockets was strewn all over the pavement, so it looked like he’d been mugged or sexually assaulted…or both.

At first he was a bit aggressive when I tried to help him up but he calmed down and went into the back of the ambulance when the crew arrived. He was well spoken and insisted that he was simply drunk and had fallen down. He also didn’t realise that his manners were missing because he told the black police officer on board that he should ‘learn to speak proper English’ and that ‘it wasn’t because he was black, by the way’. The guy was clearly ignorant. Admittedly the officer had a strong Caribbean accent and it took a few seconds to catch what he said sometimes but all one had to do was listen. I was quietly waiting for him to have a go at my Scottish-ness next.

My next call to a 30 year-old with chest pain was a no-go for me because the crew was on scene and the last call of the night (at 5.45am) was for a 50 year-old man with a head injury who was found sitting at a bus stop. He was, of course, drunk and he probably got his injury when he fell. The police were on scene and the ambulance crew was in front of me, so I swapped call signs and went home.

Somewhere in the middle of the shift, as I trundled through Soho, I saw a gang of lads, fully costumed in red and white, being told they couldn’t get into a club. I had to smile because you don’t see these things every day. Ten drunken Santa Clauses being refused entry to a night club…priceless!

Be safe.

Friday, 12 December 2008

Merrily on high

Day shift: Nine calls; Two assisted-only, seven by ambulance.

Stats: 2 Chest pain; 1 EP fit; 1 Melaena; 3 eTOH; 1 Migraine; 1 Asthma

Carol singers of various kinds (some amateur and bad at it and some professional and good at it) are gathering beneath the half-decent Christmas tree in Trafalgar Square to belt out some old favourites every day. The public have been joining in and it’s all very festive and cheery. I watched one group of carollers as the tree gently swayed in the wind above them as they went through their repertoire. It reminded me of the year (a few years ago now) when the grateful Norwegians donated the skinniest tree of all time and it almost toppled over in the first decent breeze to rise up. If it had fallen as many as two people could have been hurt, such was the emaciated nature of the thing. It was a scrawny emblem of thanks in a size zero dress when it was decorated.

Thankfully this year the carol singers can all fear the consequences of this one if it dares to fall. I say this with my usual sarcasm and humour and no emphasis is placed on the wish that it should ever happen of course. Nor is it the direct fault of the lovely Norwegians that a few of their number can't pick a decent tree from millions available.

A paraplegic man who never usually complains of pain was lying in his bed suffering chest pains and his wife decided enough was enough. His father had died at a fairly early age of a sudden heart attack, so he was in danger too. They were a nice couple and his wife even offered me a cup of tea as I carried out my obs and he clenched his chest as the pain hit again. It would have been profoundly unprofessional to take her up on the offer, so I politely declined. Maybe another time.

His ECG was anomalous; bradycardic (at 47bpm) and his p waves were inverted, so his pain was likely to have a cardiac origin.

A 40 year-old man had a fit in the street as he worked with his colleagues unloading a van. He was still post ictal when I arrived and his mates were propping him up, so I took him out of the drizzle and into the car until an ambulance arrived.

The next call, to a 98 year-old lady left little to the olfactory imagination. I walked into the flat with the crew not far behind me and found her in bed looking very unwell. She had melaena and the bed sheet and mattress were never going to get clean again. A large pool of the black, tarry excrement had formed underneath her.

She was also very cold – my thermometer simply read ‘LO’ when I tried to get a number. She had clearly been getting cold over a period of time and, as well as her obvious problem, this was contributing to her poor level of consciousness.

As I left the crew to get on with moving her I reflected on the inappropriate attire of her Japanese carer – she was a nice enough person but the way she had chosen to dress for this particular job mystified me. She had her regulation nursey-type top on of course but she also sported knee-length black boots and the world’s shortest skirt. Maybe she had a party to go to afterwards.

I didn’t make much of an appearance at my chest pain call; the traffic and inexact location of the call put paid to that. The crew was already on scene and I had wasted my time.

Try not to fall too deeply asleep on public transport – you’ll wake up to find me, my colleagues and a few police officers around you. This was the experience of the ‘unconscious’ male I attended on a train. Everyone else had disembarked at the station but he was left slumbering in his seat. The rail staff did their best (so they told me) to wake him up but, convinced that he was beyond their help, we were called.

The poor young man had just been released from prison and was making his way to London to meet friends and get on with his life. Now, fully awake and looking very intimated by the people around him, especially the cops, he was doing his best to plead innocence as he explained that he’d had a few to drink and that he’d simply gone to sleep. No crime in that but his ID had to be checked and his onward journey delayed. The crew and I left the police to take care of him.

We’d hardly had time to complete the paperwork on that when a police officer asked us to look at a 35 year-old man who’d been taken to the police office after people had seen him behaving strangely on the platform. I’m not sure what they meant but when I popped in to see him he seemed out of it. I asked him about drink and drugs and he admitted both – his pupils were pin-point but that can mean something or nothing. In combination with bizarre behaviour and a noticeable reticence to answer honest questions, it usually means something.

In the ambulance he denied taking any drugs and his GCS instantly improved; funny that.

The migraine belonged to a 19 year-old shoe-shop assistant who was a regular sufferer but who’d forgotten her usual meds today. She was photophobic, nauseous and in no mood for work. On the way out of the shop she opened her personal bag for one of the other staff members to see – this was to show that she wasn’t stealing goods from the place. She still had the capacity for honesty even though her head was making life miserable for her.

An alcoholic with palpitations and who was ‘not alert’ got a Red2 and we were scrambled to her aid like the heroes we are. The crew was on scene so I didn’t even meet her but I’m sure her palpitations were nothing to do with illness and her ‘not alert’ status had been awarded to her because she simply didn’t know how to answer simple questions. If a patient with a genuine problem dies because of one of these calls nobody will care – except of course those of us who do care.

My last call was for a very overweight young woman who had an asthma attack at a train station. She was sitting in the medical room when I arrived and, although she was breathing quickly, she didn’t seem to be having too much trouble. Her sats were good and I heard no wheeze. Her inhaler had run out, so calling an ambulance was a sound idea but she seemed agitated; preoccupied and a little unsure. She spoke to me when I was on my own but she clammed up completely when the crew arrived and the female paramedic asked her questions. Her asthma didn’t seem to be the problem – something else was going on but I didn’t stick around to find out what. I went home.

Be safe.

Thursday, 11 December 2008

Sarah's day

Day shift: Ten calls; one left at scene; nine by ambulance.

Stats: 1 Vomiting; 2 eTOH; 1 RTC with minor injuries; 1 Chest Pain; 1 Purple plus (dead); 1 Faint; 1 Flu; 1 ? assault; 1 Abdo pain.

Sarah was my EOC observer for the day and this was her first introduction to death. Seeing your first dead person can invoke a lot of different emotions, depending on your age, experience and character. She was apprehensive but remained calm and collected – as it should be under such circumstances.

Taking EOC observers is a good idea; they get to see, first-hand, what it is we are doing out here and why we complain so much at times. They can see why the system is generally useless.

Before we went to our dead lady, we were sent to numerous other calls at the head of the day. Our first was a vomiting 54 year-old woman who’d recently had her tooth out under local anaesthetic and was possibly reacting to it. Other than that, she was in good health. Her daughters were on scene and one of them travelled with her to hospital.

As if to prove the worth of our services out there, our next call was for a collapsed male who was sleeping and vomiting in the street. He was a stone’s throw (if you have a good arm) from the local alcoholic/drug abuser’s hostel and so logic led me to believe this is precisely what we’d see. He was smelly and dirty and messy. Two cops were standing vigil over him as the ambulance swept past after missing the windmill. I managed to catch it and stopped on cue.

There wasn’t much to do but take basic obs and assist in hauling him off the pavement and into the ambulance. He had filled his trousers (just for us, I expect) and the stench from that end was over-powering at times but he wasn't in emergency need of anything medical. Trust me; he was drunk and no more than that.

As we sat on stand-by, a woman stopped at the window and told us that a RTC had taken place just behind us. I called it in and Control sent the CAD down because it had already been reported and a MRU was on its way (I know, your brains are confusef by the use of 'a' before RTC and MRU but them's the rules).

Sure enough, on the short sprint up to the location of the RTC, a motorcycle unit turned into the road but he went off, past the accident scene. To be fair, it wasn’t obvious because the motorcyclist who’d been knocked off his bike by a car was standing with a small group of people at a corner and if you blinked (or followed the navigation system) you missed him.

He’d been side-swiped by a car at a junction. This caused him to come off his bike at about 30mph, slide along the road and, according to witnesses, slam head-first into a tree. He couldn’t remember the tree part, so he may have been momentarily knocked out. He had grazed fingers and a red mark on his head – so minor injuries with no neck pain or other problems. He was lucky not to be dragged under the car, the driver of which stuck around with the witnesses to talk to the police when they arrived. Oh, our MRU got on scene a few minutes after me when he realised his mistake. I could be smug for a few minutes.

In my experience Italians aren’t shy people. My next patient was a 52 year-old lady who seemed keen to express her concern at the onset of chest pain by exposing herself without invitation. Luckily I had a chaperone to save my blushes. The lady had developed the pain without any history of illness or cardiac problems – it was probably muscular, or stress-related because she was very hyper…another attribute of Italian people I find. I left this smiling, worried woman talking at a hundred miles an hour with the bemused crew.

On the way back from this call I was asked to attend a possible death. There was already a crew on scene and another FRU was parked up when we arrived on scene. We went into the block of flats and arrived at the door of a terminal cancer sufferer who had died in bed.

She was sitting up, propped by pillows. Police were on scene and the crew were getting on with the necessary procedure for recognition of death. The woman’s eyes were closed and there was no pain on her face. She had died a few minutes before the first crew arrived – apparently she’d coughed noisily and then fallen silent.

Sarah got a few minutes to recover but she was fine to be honest. I doubt the memory of it will leave her for a long time, if ever. Everyone remembers their first dead body.

Ear infections can cause other problems, including faint as a result of dizziness and loss of balance. A 40 year-old man lay on an office floor, smiling at me as I asked him about the events leading to his sudden collapse at work. He had no historical reason to pass out except his recent ear infection, which had been left to ‘clear up on its own’ by his doctor. He was very pale and unsteady on his feet so he was taken by the crew for further checks.

The same crew appeared on the next call for a 77 male who supposedly had chest pain – this Red3 was given to us after a cancellation (for higher priority) on a Red2 for an unconscious person. Where’s the logic?

In the end the drama was pointless because the man had flu and was laying in bed with a high temperature, surrounded by a family with coughs and sniffles – no wonder he was ill. The chest pain had been thrown in and taken seriously because he had suffered an MI earlier in the year. Nevertheless, he was not having a cardiac event – he was suffering the effects of a family of open-mouthed coughers. Now I felt at risk from them and I can’t afford to be off work ill.

The daughter of the man had tried to call his GP but the receptionist (who is neither medically trained nor able to give advice) told them to call an ambulance. Even the doctor palmed it off on us – he wouldn’t go to see his patient. Medical professionals can be the worst abusers of the ambulance service – some of them truly believe we are no more than taxi drivers. With the pressure of work and the lack of personal care that goes with it, we become the means to an end.

Another doctor-influenced call but this time I suspect he was a medical student calling himself one. Again, some of them think we are thick and know nothing of the processes involved in medicine. A qualified doctor would be the first person to give a student short-shrift for adopting the mantle but we are simply paramedics and to some of them, we wouldn’t know…but we do.

He’d called us for an ‘unconscious’ male in the street. The description informed me that there was a ‘dr on scene’ and when we arrived I saw a lump of human obstruction on the pavement and a young man hovering over it – this, I presumed was our doctor (the hovering man...not the lump).

The man on the ground was conscious and had never been unconscious by all accounts. He was alert enough to pull his arm away from me when I tried to get him to sit up or show me his face. His hood was over his head and he was curled up like a big baby. He simply refused to communicate and had no intention of moving from his bed, so the police were requested to help me move him if necessary.

Meanwhile the ‘doctor’ decided to stick around and watch the proceedings.

A crew arrived by the time I’d managed to get something tangible out of the man. He heard mention of the police and sat upright, chatting to me as if we were old friends. He was a big Scottish man from the far north and so maybe our common origins had more to do with his response than the threat of arrest.

He had no idea where he was and, although harmless, his ID would have to be checked in case the police had an interest in him.

When they arrived, he was asked the usual questions and none of the answers, apart from his name and where he lived, made sense. He was miles from home and was under the impression that he had to visit a detox centre somewhere locally – there are no such places near to where he was found. Neither was his behaviour fully explained, nor his inaction when I spoke to him initially.

He was left to the crew after he failed to guide them to anywhere sensible when asked to locate his destination.

A 50 year-old man claimed he was assaulted by three men on his way to a tube station in south London. I found him with a minor head injury, sitting on a bench at an underground in the north of town. He told us that he’d been hammered by a brick and then beaten up but there were no other injuries on his body – not a bruise or mark, except for an old stab wound on his abdomen. His language was drunken and mildly aggressive (he threatened retribution on his attackers). I’d asked for police but cancelled them when I became more convinced of his ineptitude at story-telling – his facts were all over the place - than the genuineness of the origin of his injury. He seemed shifty and I believe he was playing a well-rehearsed game.

He’d have to go to hospital for the head injury but as soon as he saw the female crew member he said ‘I’m not going with her!’ and tried to veer away into the main station. I steered him back in the right direction and reassured him that he was only going to get his head seen to. I meant that in more ways than one.

Haemachromatosis is a genetic disease that elevates serum iron levels and can lead to organ failure. The last call, for a 60 year-old female who worked in a gallery and who’d fainted, had me convinced that she was suffering the effects of her long-term illness. She described a sharp pain that flashed from her Pancreas to her Liver and she was weak and unsteady on her feet.

There’s not much we can do for her ailment so she was taken to hospital where a proper test of her blood could be carried out to negate any other problem.

Thus ended Sarah’s day on the FRU – it was busy and varied and typical of what we do on the road every day. It didn’t daunt her and she’s just as keen to be a part of it as ever. Obviously my recruiting tactics are working well.

Be safe.

Wednesday, 10 December 2008

Clock stopping

Clock stoppingDay shift: Six calls; six by ambulance.

Stats: 1 Asleep; 1 Flu; 1 GHB overdose; 1Vomiting blood; 1 PV bleed

I bought a can of instant de-icer and used it on my car windscreen this morning (I mean my own car, not the FRU). I get up early enough, so it annoys me to get slowed down by a thick, unyielding layer of ice. The FRU doesn’t present me with this problem because it has usually been out all night and is warm and ready to go when I get into work. It’s usually dirty though; a 24-hour rotation gathers a LOT of London’s crud on the paintwork. Sometimes I get a chance to wash it, sometimes I don’t. This morning I don’t.

I have to wake up a sleeping person on a bus, so it’s obviously a Red call. In my years of serving the bus companies on behalf of the LAS, I have only ever had one truly unconscious person to deal with (if memory serves) and he was an overdose. Usually I just jump on board, wake them up and jump off again. I should get a bus pass for it.

I arrived and the bus driver apologised because they aren’t allowed to touch people, apparently. So, I wake the guy up and he springs to life. ‘Aw, just ten more minutes’ he pleads. What am I, your mum? I think.

It turns out he’s homeless and this is how he keeps warm and gets some sleep. I feel sorry for him and tell him that I will arrange for London Street Rescue to help him. He agrees to meet them at Trafalgar Square but wants to get the bus there. I know exactly what he’ll do if he gets on another bus; he’ll fall asleep on a warm seat and we’ll be called back out to wake him up. So I advise him to walk and get some fresh air.

I’m glad that we yellow and green people of the LAS command respect and that our advice is always heeded and taken seriously. Except we’re not and its not- I watched as the homeless young man jumped on the next bus coming down the road.

A Red2 for someone with ‘flu again. She has fallen and has a head injury, the description tells me as I speed toward the bank where she works. The crew are on scene with me and when we get to her she’s lolling around on a sofa in the basement with a concerned colleague watching over her. Okay, she does have emotional issues caused by recent events but she has no head injury and her ‘flu is not an emergency.

The bank is closed for staff training, so it’s eerily quiet down in its bowels. It’s an old bank and there is a display case on the wall as soon as you enter the front door. It contains items I wouldn’t expect to see in such an establishment – guns. About half a dozen aged rifles hang in there as if mocking any would-be robber who dares to cross the threshold. I found it bizarre; it would be like having a display case full of various pools of vomit in an ambulance station. There is a valid analogy there – you just have to think about it.

A cancelled call and a good example of why the system needs a re-think. If we get a call for someone fitting, it’s Red. If they recover and are no longer fitting, it gets down-graded to Amber. The call I was cancelled on was for someone who’d collapsed (near faint) so it was a Red2 BUT when the update stated that she was ‘coming around’ and ‘thinks she might be pregnant’ the status of that call remained unchanged. Every single element of fact on it suggests it is an Amber1, if at all. Personally I would have given it a Green status or suggested she visited her GP and got a test.

Incidentally, this is an example of downgrading calls if you were at all curious. We can do it when we want to. FRED does it too.

The MRU was on scene when I got to the flat of a 33 year-old man who’d overdosed on GHB. It wasn’t his first time and he’d been in hospital on an almost regular basis because of his own stupidity. Now he was on the floor of the cramped little room being narc’d by my colleague (you might as well in case opioids have also been taken).

His two worried friends stood by as he began to clench and thrash and wriggle around. He wasn’t aware of anything really, he was tripping. Sometimes his episodes were so active that his mates thought he was fitting. He may well have been because he was mushing his brain with toxins.

A 56 year-old alcoholic lady who was vomiting blood kept apologising because her visiting relatives had called an ambulance. ‘She has Pancreatitis and if she bleeds she may bleed to death’, they stated confidently as I asked them what had happened.

True enough, if she has oesophageal varices, she may bleed to death as a result of sudden rupture but the little spots of blood stained sputum that they had collected in a plastic bag for us to examine didn’t convince me…or the crew, that this was the case.

I radioed Control and asked if they had sent me the next call by mistake. It was for a woman who was bleeding PV after an operation. She was still in hospital and a stretcher had been requested. I don’t carry a stretcher and my role is limited to first response, so I couldn’t see why on Earth I would be helpful to medical staff in this instance. Yes, I was to continue I was told.

So, I arrived and the nurse who met me took me straight to a small operating theatre where a heavily sedated woman lay, surrounded by a full theatre team, including a surgeon and several doctors. What was I supposed to do here? Stop the clock was the only good answer.

It was embarrassing because they all knew I was useless to them and all I could do was smile, chat and wait for the ambulance to arrive – but, hey that doesn’t matter because Orcon has again been served. Disregard the possibility that a real patient elsewhere could have done with my help.

Again, this is the system’s fault and our Government encourages such nonsense to appease the plaintiff public who think that targets mean better service. They are wrong.

Be safe.

Sunday, 7 December 2008

Clear blue eyes

Day shift: Six calls; six by ambulance.

Stats: 1 DIB; 1 Unwell adult; 1 Collapse ? cause; 1EP fit; 1 Fall with head injury; 1 ? Pneumothorax.

My suspicious mind is telling me that the heating in our little station has been programmed so that we don’t hang around too long inside and get out there on area cover because it’s warmer in the vehicles. I’m wrong, I’m sure but you just never know these days.

A quiet Sunday but a couple of early calls to keep me awake, starting with a run up to Great Ormond Street Hospital (GOSH) for a 28 year-old Indian lady who’s suffering SOB. She was given an inhaler by her GP but left it at home; she has a child in the hospital and has been staying in the parent’s accommodation block.

A doctor and the nursing staff are taking good care of her as she sits in the treatment room, wheezing slightly. She has an obvious tracheal tug but there’s no effort on her face; she’s just quietly having breathing difficulties. Her husband is there and he speaks English, so together we try to solve the problem.

She’s never had this problem before in her life – not before she arrived in the UK a year ago. I figure it’s either a cold-air or stress induced thing. There is nothing more worrying than having a child in hospital; especially intensive care and this weather can be no good for lungs acclimatised to a milder environment. Even though it gets cold in The Punjab; I’m told it never gets so damp.

She settles down with a nebuliser and I wait almost 30 minutes for the troops to arrive and take her away – the shift has just changed and I am taking point until a crew has completed their VDI and equipment checks.

When they arrive the patient is already much better and off the oxygen. She is still tachycardic at 130bpm and is quite scared of the prospect of going to another hospital – she looks like a frightened, vulnerable child.

Another frightened, vulnerable person was my 83 year-old patient on the next call. She had claimed chest pain but didn’t have a cardiac problem at all. When I arrived and knocked on her door, she didn’t answer, so I pushed the door open, almost expecting to see her collapsed on the floor of her hallway. She was shuffling towards me, apologising for being so slow. The she started to cry.

She had recently been diagnosed with a chest infection and woke up this morning so weak that she could barely wash her face. She was clearly an independent woman who was upset by this sudden deterioration in autonomy. It comes to us all eventually.

I’d barely begun my obs when the crew arrived; I’d been busy consoling her and getting the information I needed from her. I carried out a FAST check and it was negative – my feeling was that she had become run-down by the infection. This poor, frail old lady just needed reassurance and some company.

I left her to the crew and she seemed to be perking up a bit. They’d take her to hospital and she’d get the care and attention she needed I’m sure.

A 50 year-old man was found lying in the street by an off-duty nurse from a local Health Centre. When I arrived a MRU was on scene and, from a distance as I approached, it looked like he was resuscitating. The man was conscious but not responding at all. He had his eyes open but didn’t react to anything we said or did. He lay in the wet road while we waited for an ambulance and did all we could to keep him warm and safe.

His obs were normal but his collapse and subsequent behaviour suggested a possible CVA – a FAST check would have been impossible without his compliance and that wasn’t forthcoming.

When the crew arrived and took him on board his condition hadn’t changed.

A call in Oxford Street had me starting at Centrepoint and slowly working my way along until I got to the correct location. It had come in as a fitting at the Tottenham Court Road end but the details changed again and again as I looked for a windmill or anything that would be a clue to where I needed to be. It was very frustrating; I have no crew mate to look out and guide me, so it’s very dangerous doing the driving and the looking on a busy road like that. Eventually, someone got the details to me and I was heading for Regent Street in fact. Call connect has a lot to answer for.

The 20 year-old had dropped in the middle of the road without warning and was seen to fit for a few minutes. He was lifted to safety by MOPs who were around him at the time. His mother and family had walked ahead of him so didn’t know what had happened until they turned round to see where he was. It was a shock to all of them; he had no medical conditions and had never had fit before in his life.

The street was crowded and the road was busy, so it was a dangerous area to hang around in. The crew arrived soon after me and I was able to expedite a quick removal into the back of the ambulance. He was very post ictal and reluctant to allow obs to be carried out on him at first but as he recovered he became more human again.

His sisters were crying at the roadside, so they needed reassurance. I took one of them and the patient’s step-father in the car so that they could all join him in hospital. They had travelled into London to go shopping but hadn’t even got their credit cards warmed up when this incident ended their day.

Next, a 23 year-old man had his movie spoiled by left-sided pain which he could no longer bear after putting up with it for a few days. His girlfriend was with him and when I arrived I saw that a CRU colleague was on scene. We both entered the screen area and attempted to get a history and obs as ‘Zak and Miri make a porno’ played in the background. The meagre audience weren’t put off but I’m sure they must have felt cheated somehow as we practically shouted at the patient in the back row in order to be heard.

After we’d established a non-cardiac origin for the pain, he was moved out into the doorway and sat down on a chair. I listened to his chest but I’d already reached a conclusion based on his height and frame; he was 6ft tall and quite skinny. He’d told us he was lifting heavy objects before the pain began and that it was worse when he breathed in. He possibly had a spontaneous pneumothorax.

To be safe, he was taken to the ambulance where an ECG was carried out. I didn’t stick around with the crew to find out one way or the other; I had a chat with my CRU friend instead – you don’t get much chance to chin-wag in between calls as a solo – it was therapeutic.

I ended my shift with an easy one – a 77 year-old lady fell backwards on an underground escalator when the man in front lost his balance and fell onto her. She was waiting for me in the station office and, as usual, the staff was taking good care of her. She was badly shaken but, apart from a bump to the back of her head, relatively unhurt.

I examined her eyes and noticed that they were in very good order for her age; clear and without a hint of cataract or opacity. I think it made her day when I mentioned that to her. I left out the ‘for your age’ part of course.

Be safe.

Saturday, 6 December 2008


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

Stats: 1 COPD with SOB; 1 Unwell adult; 1 Abdo pain; 1 Hyperactive person.

There’s no frost on the ground but it’s very cold and an unkind wind makes life miserable outside of a warm stab vest. Oxford Street and Regent Street have been closed to traffic all day, so that's going to cause chaos. Plus, just to amuse me, they are digging up bits of road all over the place, coning them off and going home for tea...what's that all about?

As usual with a Saturday morning, the first call is early on in the shift and it’s a 64 year-old Glaswegian man with COPD and SOB. He’s rude initially but that’s because he’s having a lot of problems breathing, so his abrupt attitude is forgivable.

‘Come in!’ he yells when we knock at the door (the crew is with me on this one). We’re already half way in and at least we know where he is. ‘I’ll answer your questions when I get oxygen’ he complains between wheezy breaths.

A quick neb and some patient care and he’s able to pull himself onto the chair for the two-flight trip to the ambulance. I leave the crew and get on with the rest of my day.

Three vehicles arrived up for a ‘chest pain’ that turned out to be an 80 year-old Italian lady who was generally unwell. The MRU, ambulance and myself arrived one after the other and we ganged up on her in the little bedroom where she lay. She wasn’t in trouble and there was no need for all of us to be present but it was nice to see and catch up with old friends from my previous life in Islington.

When my MRU colleague and I went back down to our vehicles we were greeted by an almost-spitting mad woman whose car had been inadvertently blocked in by us when we arrived. Our blue lights were on, so we were advertising an emergency but she didn’t care and ranted about how selfish we’d been…only thinking of our patient instead of others. I found that comment quite incredible.

The fact is, we couldn’t have parked anywhere else because the road did not allow for it – we had no choice in the matter and we never deliberately set out to ruin your day when we arrive on scene. We’d rather not be there quite frankly.

I asked the lady how she’d feel if it was her mother we were attending to. I got no answer and a dirty look. If there’s a letter coming, it won’t be a thank you note.

To help out, my colleague jumped in the ambulance and drove it down the other end of the road, where he assumed the crew and patient would exit the building (and I suppose to defuse any other angry driver nonsense we may be risking). The crew, however, were on top of the steps just behind me and now they and their vehicle were parting company fast. It was quite funny to watch.

I managed to catch the attention of my colleague all the way down the end of the road as he began to helpfully lower the rear ramp. He realised his mistake and u-turned to get back to us. The patient was fine about all of this as she waited for the return of the vehicle. I told her it had been stolen and a replacement was coming and that seemed to make her smile long enough to cover our tracks. It was very amusing.

Abdominal pain is one of the most common types of call we receive on a regular basis. For some it’s nonsense…for others its agony. My next patient, a 23 year-old woman with IBS lay on a sofa in the basement of a restaurant, writhing about in pain. She was on the first day of her period and had just gone to the toilet when the pain struck. I spent more than half an hour with her, her friend and a member of the restaurant’s staff, as we waited for an ambulance. The closed roads and thoughtless road-works were slowing down the response to calls in this area and my patient’s pain wasn’t getting any better.

She vomited violently a few times and I gave her morphine to help her cope. It had to be done in almost total darkness because the cellar’s lights didn’t glow any more than above 10 watts (it’s a night club). Cannulating in those conditions is problematic, so my little pen-torch was deployed and I had the manager hold it over the girl’s arm. This time, I was accurate.

When at last the crew arrived, she was much more comfortable. I usually employ a simple test to confirm that the morphine is working (with females only I should add). I ask if the pain score has gone down and if I look more handsome. Obviously a positive answer will verify that the patient is delirious and thus the drug is working.

On the way out to the ambulance (she was now able to walk with support), she wrapped herself around me to keep warm and I found myself supporting her in a hug as we slowly made our way to the vehicle. She wasn’t shy, that’s for sure. I felt a bit awkward but then I shrugged it off; this was my job and she clearly trusted me, so her proximity for heat and comfort was part of the care package.

I was just around the corner when a call came through for a 40 year-old woman who was ‘feeling faint’. A quick trip to the underground station and I was briefed by a staff member before I’d set eyes on the patient. She was in the little office and told me she had ‘felt strange’ all day. She was wobbly on her feet and very jumpy when I touched her. She was definitely wired.

‘I don’t suffer from anything but I feel weird – it might be all the Red Bull I’ve been drinking recently’, she said, calm as you like,

‘How much have you been drinking?’ I enquired.

‘At least five cans a day’.

‘With or without vodka?’ I cheekily ventured.

‘Sometimes with’.

Some nuts don’t need to be cracked; their shells just fall off during interrogation. She went on to tell me that she had been under stress recently and that the Red Bull (sometimes with vodka) had been her coping mechanism. Fair enough – better Red Bull than cocaine or Heroin, right?

Once the mystery had been figured out and the crew had checked her over thoroughly (all my obs were normal), she was allowed to go on her way with advice to cut down on all stimulants until she’d flushed them out of her system. She hadn’t wanted to go with the crew to hospital anyway…and she didn’t need to, clinically. She’d probably fly home now...

Be safe.

Monday, 1 December 2008


Night shift: Six calls; two assisted-only; four by ambulance.

Stats: 1 RTC with ? # collar bone; 2 Flu; 1 eTOH; 1 DIB; 1 Unconscious.

My first call on this cold, rainy night for a RTC, car vs motorcycle, with an unconscious male turned out to be a simple fall from a motorbike. Oh and it was a female…and she was conscious.

The incident took place on one of the bridges and so rush hour traffic quickly began to foul up, especially as I had no choice but to park on the other side to avoid going all the way around and back again. If it had really been an unconscious person on the ground, that delay would have looked uncaring. So I was blocking one lane of the northbound road and the accident scene was taking up two on the southbound road. I doubt the drivers approved.

The lady had fallen from her motorcycle when she lost her balance after braking hard. Now she was sprawled on the wet ground with a possible broken collar bone. She’d bust it before and knew the pain from experience, so I believed her. I felt the bone and sure enough there was a change in its natural line. Other than that, she was fine.

Passing motorists had stopped to help her and a few people were directing traffic but I needed proper control here, so I called for police and ambulance assistance and got it within five minutes. HEMS were cancelled – this wasn’t big enough for them.

Inside a barely furnished flat lay a Somalian woman who’d called us because she had chest pain. It didn’t take me too long to diagnose a simple case of ‘flu and we have recently been running around ‘treating’ many patients for this. Her daughter stood by as we chatted and I advised her to see her doctor. The chest pain was the result of a dry cough. She had a slightly elevated temperature and she looked sick in the usual flu-type way but she didn’t need an ambulance and she shouldn’t be sent to a public place where she can spread the love, so we agreed that she could see her GP in the morning.

They were lovely people and more than willing to accept the minor nature of the ailment, so I got my PRF signed and set off for the next call.

My only drunk of the night was a 20 year-old man who had collapsed in the middle of Shaftesbury Avenue. He lay on the pavement as people stepped around him until two helpful young men decided to move him out of harm’s way and call us. They had tried to rouse him but he was in one of those deep, deep pseudo-coma type sleeps that only the very inebriated enjoy. It took me two seconds to wake him up.

‘Can I go home?’ he asked. I think he was requesting a lift. Instead he got an ambulance to hospital. He’d admitted being depressed and taking in far too much booze in a futile effort to make his troubles disappear. He was lucky to have had his body saved from the road – his mind and soul were damaged beyond the help of mere mortals I fear.

The second ‘flu call took me to a 42 security guard who had a back ache. DIB had been stated to get a Red response out of it but when I spoke to him, he had no trouble speaking at all. His back pain had been going on for weeks and his ‘flu had already been diagnosed by his doctor. This was his first night shift and I don’t think he fancied working. I wish he’d had the guts to just book off sick like everyone else does when they are under the weather. Calling ambulances for leverage is nonsense.

He was left where he sat.

Up north next for a 76 year-old with difficulty in breathing. His wife buzzed me in and as I entered the front room she pointed at the armchair opposite her. All I could see was the back of someone’s head and it wasn’t moving. My initial thought was that I was going to find the man in cardiac arrest but when I looked at him I could see that he was alive but not well. He was suffering severe shortness of breath and his pulse was very slow and irregular. I recorded 44bpm when I took it for my baseline.

The crew arrived to take him away after I’d given him oxygen and established that, apart from his sudden SOB on waking up, he felt normal. He had no significant medical history.

His wife told me that she’d be unable to cope on her own and couldn’t go with him because she wasn’t good on her feet. I could have asked the crew to return and take her with him but I thought they’d be too busy and there was always the risk of the man’s condition suddenly deteriorating in the ambulance.

It was early in the morning and the woman had no neighbours under the age of seventy who could be with her, so I asked Control if another ambulance could be sent so that she could be carried down the stairs and taken to join her husband. I thought it was important that she be there with him…again, just in case. I wouldn’t want to see my loved one leave in an ambulance and never see them again just because I was unable to go with them.

It was a cheeky request and there was no medical emergency as such but it was an act of kindness on behalf of the LAS. My request was granted and another crew showed up no more than twenty minutes later to take the frail man’s wife to his side. So my genuine thanks to the Control staff and to Sector for doing this for me...and to the crew for tolerating me.

My last call of the night was in Soho. It was a Red2 for a man with a headache. I called Control to query the details and was told he also felt faint, thus the red category. This sounded strange from the start and I made my way there quickly. I arrived in a narrow street and saw a police van in front of me. I was waved down frantically by one of the local taxi touts. A cop was standing over the body of a large black man who had been put in the recovery position.

‘He seems to be sleeping like a baby’, the police officer told me as I approached.

I tried to rouse the man and looked closely at him – he was unconscious. His pupils were pin-point and his breathing was noisy. He looked very like the man I’d dealt with a few shifts earlier in the burned-out flat, just around the corner.

I moved him and he vomited. His tongue protruded from his mouth as he snored and gasped deeply but he wasn’t waking up. I gave him a shot of Narcan and repeated it after a short time but it had no effect at all. His obs were normal but I was unable to get a blood pressure because of his position and the fact that his airway was so messy and difficult to manage (thus a priority).

No ambulance arrived and I struggled with the help of one police officer for twenty minutes until I requested an urgent response – then I got a FRU to back me up. In fact, I later learned that he’d overheard my request on the radio and volunteered to assist. I was certainly glad of his help but what I really needed was an ambulance. Between us, the cop and I had to move the patient’s position, clear vomit from his airway and control the crowd that had gathered around to watch.

My FRU colleague helped for a few minutes as I started to bag him (his resps were inefficient now) but that induced even more vomiting. In fact, every time we went near his airway he seemed to throw up. This was bad and we knew it.

When the crew arrived we took him into the ambulance (this was a very heavy big man and it was a fumbling carry on just to get him on the bed) and continued his critical care. When an LMA was introduced to protect his airway he projectile vomited through the lumen, causing the stuff to splatter all over the opposite wall and door. Some of it went onto and into the other paramedic’s bag. Mine’s, thankfully was clear of the danger zone – after years of dealing with West End drunks I have a knack of avoiding most of the splash.

We discovered that this man had been diagnosed with Malaria a few weeks ago after a trip to Nigeria and I wondered if this had caused his sudden collapse in the street. He was a taxi driver and his headache had come on very quickly, according to his colleagues. He asked for a drink of water and promptly fell down unconscious.

When he arrived at hospital his condition hadn’t changed at all. He looked like a man who’d suffered a major intracranial bleed and I did some investigative digging to find out if Malaria could cause this. I learned that Plasmodium falciparum could cause Post-Malarial Neurological Syndrome with post-infective encephalopathy occurring within 2 months after infection. Although the research is unclear about the specific signs and symptoms associated with post-infection complications leading to death, there is a possibility that we may have some across something unusual for London. On the other hand, he may well have just had a stroke.

A colleague who’d been at the hospital when we’d brought the man in told me later that he was ‘coning’ (pressure was forcing his brain stem through the hole at the bottom of his skull – the Foramen Magnum), so the prospect of him surviving is almost certainly zero.

Be safe.