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.


Anonymous said...

Did the taxi driver survive?

Well done for getting transport for the little old lady! Proper care, carried out properly.

Tony F

Anonymous said...

Thank you so much for writing this Blog! I look forward to it every time I log onto the net. Im currently a theatre nurse but hoping to become a paramedic in the next few years, so your blog is both entertaining and informative and what you guys really get out on the streets.

Thanks again,


Xf said...

Tony F

I haven't heard but it is extremely unlikely if he was coning, I'm afraid.

Xf said...