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.


Anonymous said...

Very true about never forgetting your first dead body...I was a student nurse and 21...I'm now 45 and I've never forgotten but may I add that it was a 'good' experience compared with some of the traumatic arrests I attended during my 20 years nursing.
Stay safe!

Abi said...

Hey :)

I'm a recent but regular reader of your blog... the things people call 999 for - pffft!

Anyway, I wanted to say that before I read your blog I'd decided to volunteer somewhere... but during the few weeks I've been reading I decided to get on a St John Ambulance course :) (if they'll take me!) you inspired me!

That was a lucky first dead body... the first one I saw was a victim of an RTA... blimey.

Stonehead said...

My first was when I was a 16-year-old naval cadet. We were doing a week's sea training on a destroyer and were still berthed when I happened to look over the side, and there he was. Belly up, head and feed down.

It was quite clear the man was dead, but we still did the full "man overboard" procedure. He'd been in the water for at least 24 hours with the resultant consequences in getting him out of the water and in the state of the body.