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.


Lumo said...

That giant inflatable snowman has got to be the most terrifying thing I have ever seen in my life.

TonyF said...

It's weird, I don't like that 'snowman' either. Then again I don't like clowns or scarecrows....

Cornelia said...

You sounded very exhausted and fed up. I sympathize with you and hope it gets (or already has got) better... Wish you strength and not too much drunks or other stupid, time-wasting 999 callers... :)

Anonymous said...

West Australian Ambo- Worldwide trends in drunken abuse are infectious- MOPS getting involved are affecting Perth Nightclub jobs and calls. I have also noticed a higher level of Police swearing at MOPS, mostly due to frustration. It is still sad though and can escalate things fast- like the bottle I saw whizzing past my head at 0300 after MOPS were told to leave a scene with 'Authoritarian' voices. I much prefer Verbal Judo type requests and strategies!

Anonymous said...

Why were the old man’s clothes – his “small pile of personal history” – just left lying in the road? Did he go into the ambulance naked? Why couldn’t any of you people be bothered to pick up his personal belongings and have them taken with him?

And why would an old man need to be “RSI’d” if he was already unconscious and therefore not moving much anyway?

Sewmouse said...

Wow, Anonymous - 35 yrs. old is an "Old Man"? I think of a 35 yr old as a "young puppy"!

And I didn't see anywhere that the goods were left in the street - just that they had been strewn about him before help arrived.

Anonymous said...


After any trauma, it is usual for patient's clothes to be cut off. That's probably why they were left in the road. Chances are, the patient was transported in relative dignity (covered by a blanket, I guess?). Also, picking up some cut-up clothes would be the least of the medics' worries - probably "bothered" more about his life than his clothes!!

Not sure why RSI (rapid sequence intubation) was used as, you're right, the patient was unconscious which would suggest ETI would be fairly straightforward, but that's the decision the HEMS team made and to be honest, it's nobody's place to critise the decision they made at the time, under doubtless very stressful conditions.

Sorry for the rant everyone!!


Xf said...


Well, someone doesn't like us. 'We' people didn't bother with his clothes because (1) we were far too busy keeping him alive and (2) it was a potentially fatal road traffic scene and the police don't take kindly to us stomping all over it and removing things without permission.

Also, RSI is necessary because it helps to stabilise the body's recovery functions, reducing the stress (unconscious or not) that exists when serious trauma affects it. The HEMS doctors know exactly what they are doing...one day it may be you they are fighting to save.

Merry Christmas!

Thanks to those of you who replied in my stead to this pedant.

bipiddee said...

"some drunken, drugged-up waste of space"
Doesn't sound like you to use those words to describe someone on anti depressants. There's a big difference between drinking too much on a night out and drinking to get rid of the pain. I don't want to be a statistic either, but sometimes I need to spend time in a&e after self harming. Guess that makes me a waste of space too. Thanks.