Saturday, 31 May 2008

Response

My last post provoked a debate and I have received a lot of comments and emails from you, thank you. It's best I deal with them here, rather than go through each one individually.

If you are young, black, white or whatever, you mustn't feel that society is against you because it is not. People who shout out at youngsters for walking along the street are ignorant and useless. There are plenty of young people struggling out there and they are good individuals with respect, courtesy and a sense of morality - the bad kids are still in the minority I feel but that again is the problem - we tend to pander to minorities and ignore the damage and segregation it causes among most of the population. What we need to do is be fair to everyone, regardless, but we have no ability to do that effectively and we fear being called something-ist if we try.

Respect for the police and teachers has diminished because kids are told their 'rights' by their parents and parents do this because they fear a lack of power when other authorities are in charge of their off-spring. They want to control their children, so they degrade the police officer's and teacher's power by spouting off at every opportunity about abuse and assault. This has its roots in the many stories that were headlined over the past decades about child abuse, corporal punishment and the very real misuse of power by a minority of those who had it - off we went like headless chickens when a few bad apples were caught. It's the same today; our armed officers are now almost ritually put on trial if they shoot an armed and dangerous man; moreso after the shooting of Jean Charles de Menenez. That, of course, was a terrible tragedy in which a communication failure resulted in an innocent man's death but nobody stopped to think of the bravery involved when those officers ran directly into what they believed was a terrorist with a bomb. After 7/7 they knew that their lives were in imminent danger but they did their job without hesitation. That is precisely why we have them, is it not? If they'd shot a terrorist and an explosion had been stopped, they'd be heroes. So, we're doing it again; we're counting the number of shots fired and soon enough we'll expect these men and women to challenge someone and then wait five minutes before firing in case they've got it wrong. I can tell you they'll all hang up their guns, as would I.

There are many more examples of such stupidity but my point is that, over time, these stories and the way they are written create an undercurrent of hatred and thus a lack of respect. Power is slowly removed from these people en masse and voila! - we have a society that honestly believes that they can tell the cops and teachers what to do and that we know better every time.

In my profession I have often felt disgust and anger at the behaviour of some of the 'patients' I have to deal with. I refuse to call them sir or madam because I will not give them the excuse to overturn my polite respect with vitrionic hatred. Those poor cops and teachers out there are under the same pressure to bow down to basically bad people. Why should they? If they input nothing to society then they should receive nothing in return. What is wrong with us? If we were a company, we'd be in liquidation right now.

My message is simple if you care to listen. Don't tell our police force how to do their job and trust that the majority of them are good and fair. Don't tell your kids that the teacher can't punish them because that just opens up the flood gates and they will go to school knowing that they can do what they want!

If you are a parent, look at your children; consider how they behave towards you - it's a real clue to how they are behaving towards others.

I watched a little gang of hoodies walking up the street in north London as I travelled home; they were all black kids. They looked like they were going nowhere really and stayed pretty close together as they walked along. I considered what I'd do if I was a cop. Would I stop and search? If they were white, would I still do the same? If they carried a weapon, what next? I felt like a racist just because I immediately thought they were up to no good but everyone has an instinct about people and you can tell when someone is a threat and when they are not. How many times have you crossed over when you've seen a group of young men walking in your direction? Would you do that if they were women? Does that make you sexist?

On the flip side, I've had problems with white guys and have made great friends with b
lack guys out there; it really makes no difference to me at all - it's all about their demeanour and the way they talk to me. I take no-one on face value.

Using the race card to stop the police from thwarting another stabbing isn't good enough and, frankly, you are an apologist. Most of the knife and gun crimes are being carried out by black youth in London - their skin colour has nothing to do with it really; these are bad people and they could be yellow but there has to be a bit of common sense used - targeted searching must be implemented. The same principle applies at airports, where they will search old ladies and have children remove their shoes in order to show 'fairness'. They're just too scared to be seen as racist or something-ist if they select identifiable possibilities and search them only.

It's all very complex and raises issues we don't want to face but most of us are thinking or discussing behind closed doors. Plenty of white kids carry knives but, as I said...and it's a fact...almost all of the reports you have read have involved black youth gangs, so it is inevitable that most of the stop and searches you'll hear about will target them. Sorry, but do you want to live in safety or not?

It's all too easy to sit in judgment of the people charged with our safety and the education of our children. It's time to stop it and let them do their jobs. I teach first aid in lots of schools and I have never met such a population of worried professionals in my life; most of them are too scared to put a plaster on your kids because you might try to sue them if a rash breaks out! For Pete's sake, it's all gone too far, hasn't it?

As for Liberalism; I agree, I can't use the word negatively and I didn't mean to. I am trying to express the mind-set of parents who think that freedom is allowing their kids to run riot without consequences and who tell them they are better than the rest of society, so they must cry out for their rights whenever someone challenges their behaviour. That's not a society at all, that's tribal.

Xf

Friday, 30 May 2008

Child murderers

The news is full of stories about the ‘recent’ increase in youth violence and the hot topic at the moment is the question of how we deal with it as a society. Police stop and search tactics are increasing, much to the dismay of minority groups who feel that they will be unfairly targeted and metal detectors are being introduced into public places, all to make us feel safer.

Something is missing though and the biggest issue of all is being overlooked; our children are being brought up with little regard for the law and no respect for adults – the root of the problem lies at home, often with parents who either have no respect for law and order themselves or who are too ‘liberal’ to do anything about their unruly kids.

It’s not fashionable or PC to discuss punishment when it comes to children but every society needs control, otherwise you have anarchy, starting with the kids. Almost all of our learning with respect to discipline and behaviour is derived from our upbringing and the pressure of peers as we get older. We copy the behaviour of those we respect and want to be like, so if you are living in an environment that teaches you not to fear the police and authority; where violence is seen to be the solution for every problem and where your friends are made up of the same type of person with the same upbringing, then you are more than likely to become a product of it.

The recent stabbings, more notably of the Harry Potter actor, have highlighted the difficulties we now face but they have been sown by us. I watched three young lads, probably 13 year-olds, mucking about on The Strand at 7am. They weren’t dressed for school and I’m not sure if it was a school holiday but they were amusing themselves by running around and bumping into people who were on their way to work. They used straws to blow little bits of paper at each other and then started targeting commuters as they climbed the stairs from the underground – spitting at them then running away. It seems a small issue and no more than high jinx I know, but what I was seeing was the beginning of something much more progressive – these kids had no fear of the consequences of what they were doing. There simply is no punishment for their actions, however innocuous they may seem.

What if one of those kids had knocked someone over when they bumped into them? They run away, someone possibly gives chase. They may even get caught. Then what? You can’t clip them behind the ear like in the ‘good old days’ because that’s assault and battery. You can’t even hold on to them physically because it amounts to the same thing if they decide to complain about it. One of them may be carrying a weapon and your life ends because you stood up for yourself. It all seems melodramatic in text but you read about this stuff every day now.

I’m not an advocate of hitting children…or anyone for that matter but I think a little bit of discipline at home is necessary. I grew up believing that physical punishment was normal; my natural father regularly beat me, sometimes seriously and I truly believed, at the age of five or six, that he wanted to kill me but it didn’t stop me being a naughty child because almost all children are naughty. What I needed was respect and love and I needed a strong, leading character in my life to help me decide what was right and wrong; beating the hell out of me for stealing sweets from Woolworths was hardly the right way to shape my character. I was lucky, however and my step-father changed me when I was in my teens. I believe that his behaviour affected mine so profoundly that I began to see sense.

I won’t even drop litter – it would make me feel guilty! I’m not perfect but I have a sense of social responsibility that is part of me now. The kids that are killing each other have no such sense; they have a hierarchy within their peer group and that’s pretty much where their allegiance lies. That doesn’t mean they can’t be changed but the older they become and the longer we wait, the harder it will be to affect them. That’s why the Government’s new video on knife crime is such a joke. Young people who were asked to comment on it suggested, quite correctly, that it wouldn’t make any difference because it almost glamorises violence and ‘we see worse on video games’. Another spokesperson for youth stated that knife carrying youngsters often film their own acts of violence anyway, so giving them a professional produced piece of fiction is laughable.

The recent murder of 17 year-old Amar Aslam, who was beaten to death in a park in broad daylight should hint at the value of the Government’s weak efforts to thwart the spread of such acts because this young man wasn’t stabbed or shot, so whether a weapon is used or not is irrelevant to the problem.

His mother appeared on the news and she stood bravely in front of the camera asking that people ‘bring up their children responsibly’. Now, I have been decried by at least one critic of my book where the hint of racism was used to defend his/her description of a single line in which I specifically mention how impressed I was with the behaviour of the Muslim families I have visited in the course of my profession. I was simply defining something that has also hit the headlines recently - the decline in social values as a result of the deterioration of Christianity as a backbone for good values. I am not a religious person but I truly believe that we all need guidance and religion, or any belief that teaches moral fortitude, is important in society. The Islamic faith, notwithstanding its very few radical followers, among many other faiths, is so strong among its people that you don’t tend to see decline in family values and therefore children’s behaviour with respect to the law and basic respect for others. I am, of course, reflecting only on my own experience with such families.

Even our pets are taught right from wrong. I would argue that people who allow their dogs to wander around and foul the streets are the same people who let their kids run riot and go out at night without any thought of where they are or what they are getting up to. It’s entirely natural for young children to disobey and take risks; without this instinct they would never learn for themselves but without consequences and punishment, neither will they clearly learn the difference between right and wrong.

As long as we continue the debate without dealing with the root of the problem, we will churn out new generations of indifferent, socially inept people and they will have children who act the same way.

In the United States it’s not uncommon for drunk drivers to be taken to the morgue and shown the result of their carelessness. Why don’t we do the same with anyone found carrying a knife? And please don’t bleat to me about how cruel that would be; if you carry a deadly weapon you deserve to be shown what it will do to someone if used. Show these individuals a couple of stabbed or shot corpses – tell them who they were and what family they had – shock them into realising what they will end up like.

Another sound argument, in my opinion, is the reintroduction of National Service. Again, it’s not a popular liberal solution because there will always be those who say that teaching our youngsters to kill is counter-productive but the army also teaches respect, discipline and teamwork. I’m not na├»ve, I’ve been a soldier and I know there are imperfections there too but look at how deep all this is running – our armed forces are under attack by the very people they defend just for doing their job, whether politically that is right or wrong is irrelevant. This is just another clue to the decline of respect and it comes about in this case because some people have lost faith.

Our children have no faith in the system because all we hear about is how corrupt and dishonest our elected leaders are. That is completely understandable; if you look up to someone and they disappoint you then trust and respect is gone. Many of our kids live in poor, underprivileged areas and have little choice but to turn to gang culture, drugs and violence in order to survive. This isn’t their fault – its ours.

I wouldn’t dare to take the moral high ground here because I know how bad I was as a child and I still remember the need to be popular and give in to peer influence but if all children understood where the line was and what the ramifications were then crossing it would require greater consideration.

A spokesman for black youth in London put it very succinctly on the news recently; those who carry knives have power and credence in their peer group (or gang if you want) but once they’ve killed someone, where do they go from there?


Xf

Thursday, 29 May 2008

Ghostly gunman

Eight emergency calls; one hoax and seven taken by ambulance.

An evening call to a 60 year-old woman who’d collapsed at an underground station started my shift. She was lying in the recovery position on the floor, surrounded by her family and underground staff. She was very pale and said she felt weak – she’d gone to the floor as she walked towards the stairs leading to the platform; luckily she hadn’t actually reached the top of the stairs before she fell or things might have been a little more difficult.

Her medical history included heart problems and she was on beta blockers – she had a weak and irregular pulse, so a trip to hospital was arranged, courtesy of the crew.


A young girl sat outside a club in Soho, convinced that she was hypoglycaemic, despite never being diagnosed as diabetic. I guess she meant that her blood sugar falls to a point where it causes her to become weak – apparently someone else had told her she was hypoglycaemic and so she had taken that on board and used it every time she felt out of sorts. I tested her blood glucose and it was normal. She and her friend went to hospital anyway because she still wasn’t feeling well after I’d spent ten minutes checking that everything was as it should be.


If you have chest pain, don’t walk out to meet the ambulance. My next patient, a 72 year-old man, was waiting on his doorstep for me when I pulled up. He had a history of CVA and was now suffering from chest pain and a headache but he insisted on walking to the car and explaining all that through my window as I attempted to get out and help him.

The ambulance arrived within a few minutes and I’d already settled him down in the back seat of the car and recorded as much information about him as possible before handing him over to the crew.


One thing I can’t be doing with is unruly behaviour from a patient’s drunken friends as I try to do my job. It’s off-putting and a bit threatening - especially when you are surrounded by them and they are too close for comfort.

I’d been sent to a 20 year-old man who’d fallen in the road and cut his head open as a result. He was lucky not to get killed because he’d stumbled drunkenly across Charing Cross Road at a busy time of the night (early morning). He’d been knocked out momentarily, according to his friends but now he was sitting on a step waiting for me to arrive.

I put a dressing on his head and only managed to complete the job after telling his mates to calm down twice as they jeered, cheered and took photographs of their friend’s injury. I’d run out of things to do or say to him by the time an ambulance was free to take him away to hospital.


A call given as ‘fitting’ just because the patient was shaking turned out to be nothing more than an infection and high temperature (hand in hand, obviously). Some people react in an over-the-top manner when they are dealing with illnesses, even the ‘flu, and this 74 year-old woman was using her body to express how uncomfortable she was by shaking in an exaggerated way, thus the ‘fitting’ response.


Another fitting call that turned out to be something else came in the last few hours of my shift. A 40 year-old woman had been found at the London Eye, collapsed on the grass area but the details were sketchy. When I arrived, a small group of lads waved frantically at me to follow them into the park, towards the Eye itself. They explained that a woman had been helped out of the river and was now lying on the ground, threatening to go back in.

I found her surrounded by people who’d either just been going home from their night out or who’d helped the woman when she was in the water. She was soaking wet of course and shivering violently but she could communicate and was very distressed at the cacophony around her, so I sent most of the helpful bystanders away and things quietened a little.

‘Did you jump in the river?’ I asked her.

She nodded.

‘Where did you jump from?’

‘Blackfriars Bridge’, she said in a broken, whimpering voice.


I’ve long stopped asking jumpers why they do it, so I tried to get her as warm as possible as I waited for the ambulance. Time was fairly critical if she wasn’t to become deeply hypothermic. She needed constant reassurance; understandable considering the recent attempt to drown herself in the chilly Thames water.

When the crew arrived, the little crowd had dispersed but were hanging around in smaller groups, discussing this exciting event. The patient was able to walk herself to the ambulance with assistance, where she was stripped of her clothing (in private by the female crew member) and warmed with blankets. I returned to the car and got on with the paperwork.


It’s 4.30am when I get my last call of the shift and it looks like I will be tied up with it for some time – a male has been shot in the chest in the West End. I’m told to standby at a safe distance and I watch as police vehicles, including armed units whiz by in the opposite direction. Nothing happens for a while and I see no activity around my location, so I call Control and ask them what’s happening but a police car pulls up alongside and explains that the ‘shooting’ has taken place in another location from the one given. I head up there with them but there are no lights and sirens and no apparent hurry. The guy is either dead or this has been a hoax.

I arrive on scene and I’m told that it’s fiction. Nobody has been shot. Ironically (or not) it’s the same area that we often receive calls for stabbings that don’t exist – more often than not the ghost victim has been stabbed in the chest. This is a dangerous game because it has the potential to slow a response down because everyone will become complacent and someone may well be lying in a pool of their own blood one day.

Be safe.

Tuesday, 27 May 2008

Baby bingers

Ten calls; one time waster, one assisted-only and eight by ambulance.

Binge drinking by the under 16’s is on the rise and we are going to more and more calls for 10, 11 and 12 year-old offenders. Now, I know this is a ‘hot topic’ and personally I blame the parents for this too but the main issue is the serious health problems that will ensue if we don’t put a stop to it. We simply don’t know how young livers cope with alcohol in the quantities (and more) that an adult would drink on a binge.

I sat in EOC (our control centre) as I waited to see a friend and listened in on the 999 calls at the HEMS/MRU/CRU desk. As I waited and listened, a call came in for an 11 year-old who’d been found drunk. Later, while out on the road, I heard another FRU pilot say he was going to a 13 year-old drunk. I have personally treated many young drunks over the years and I remember three 13 year-olds unconscious on a park bench after an all-day drinking session. It was broad daylight.

Most of us tried alcohol when we were young, so that’s not the bone of contention; its ease of access and the obvious lack of control of some parents that’s mostly to blame. At 4am, I watched three young girls – probably no older than 12 or 13 years-old – walking past the station on their way to or from God knows where. Are their parents mad? London is a dangerous place for grown-ups at this time of day, never mind kids.

I had an observer – Olivia - out of EOC with me tonight for a few hours. It was good to have her company and we get on well anyway, so she was someone to talk to as well as being a good second pair of hands.

The night started with a 54 year-old man who’d fallen from his mobility scooter earlier and was now complaining of back and abdomen pain. He’d already been seen at hospital and his x-rays were clear but we were called out again because his carer was convinced he was deteriorating. It took a few minutes but, after a full examination, I found out that he was just too scared to stay at home in his vulnerable state. In the recent past he’d been robbed when a gang of youths, male and female, broke into his house while he was inside and threatened him. Nice neighbourhood, I thought, as he tearfully related his story, backed up by his obviously caring carer.

He was taken to hospital but I’m sure his physical problems were exacerbated by his stress. Somebody somewhere needs to do more to protect these people.


I thought the man lying flat on his back at a busy bus stop was in cardiac arrest as I got out of the car and went towards him. The 35 year-old lay motionless after suddenly collapsing in the street. Bystanders were tending to him and as I closed in, I could see that he was breathing, thankfully. I shook him awake in time-honoured fashion because, at close quarters, I could tell he was drunk.

The ambulance crew was on scene at the same time and they arrived to pick him up and take him away, after he’d opened his eyes and admitted drinking a lot.


The address of my next patient seemed almost impossibly elusive. We were in the right place but the numbering of the flats seemed completely illogical and we went up and down stairs for almost five minutes trying to locate the correct door. It wasn’t until Liv separated from me and went to explore another floor (one we’d already been on) that we finally got on scene.The man inside, an 80 year-old with chest pain, wouldn’t have benefitted from this council-planned stupidity if he’d been having a genuine heart attack but, when I eventually got to him, I found that he wasn’t. He had abdominal pain and back pain. His family told me that he’d recently been diagnosed with stomach cancer and that kind of news is bound to give anyone depression - the more I spoke to him the more I was convinced he was suffering psychologically as well as physically.

He’d been ‘jerking about', according to his daughter and he displayed this for me when I got to him but it was more of an emotional reaction to discomfort than anything else and I spoke to him to calm him down. He didn’t do it again after that and lay quietly in his bed as I waited for the ambulance crew who were, coincidentally, trapped outside and as lost as I had been. I had to send Liv to get them.


Then a regular time-waster with ‘DIB’ at a police station. He didn’t have DIB and as soon as I saw him I recognised him...and he recognised me. I’ve known this man for almost five years and have met him many times in different locations. He’s the same guy I wrote about a few months ago; the one who was sitting at a bus stop across the road from the hospital. He has no medical issues but he has psychiatric problems and learning difficulties. He also has a temper and can be aggressive, so I was quiet and calm with him but I still talked to him about wasting our time, especially tonight as it was very busy.

‘Do you want to go to hospital and wait in reception?’ I asked him.

‘How long’s the waiting time?’ he replied. That said it all really. He didn’t want to wait and so I cancelled the ambulance and got the police to call someone and collect him.


A 31 year-old man who’d been beaten up recently had chest pain in Soho. His pain wasn’t cardiac in origin, I was pretty sure of that but he may have sustained damage to his ribs as a result of the beating, so he was taken to hospital.


A short drive to a restaurant in Leicester Square next for a 45 year-old diabetic man who was hypo. Those damned pedicabs were blocking the entrance to the Square, as usual, so I was held up for a few seconds more than I should have been as the restaurant manager waved frantically for me to follow him to the patient.

The man was flat on his back on the floor and his friend explained that he had become unresponsive and fitted just as they were going to have something to eat. I checked his BM and it was 1.8 – far too low. I tried Glucogel but he was difficult to manage, so he got an injection of Glucagon, followed by more gel, which he still wasn’t taking in properly. I was treating him as customers came and went, ate their meals and waitresses busied themselves around us. Liv was valuable to me on that call and she handed me everything I needed, including new gloves because Glucogel is very sticky stuff.

I stayed with him for quite a while until the ambulance arrived (as I said, we were incredibly busy) and by that time, he’d started to make some sense and his BM had improved to 3.4 but he wasn’t completely recovered yet, so he was taken to hospital – prudent considering he’d had a fit – and his condition seemed to be improving just before the ambulance left. Oh and the pizza he and his friend had ordered was delivered to the ambulance door, which I found quite bizarre.


I was on my own for the next call and the rest of the shift – a very tired Liv went home after the diabetic call. A collapsed, drunken female in Soho had to wait because as soon as I got on scene I received a message telling me there was a ‘disturbance in the area’. Sure enough, there were cops all around me and I found myself trapped by their vehicles. Shortly afterwards, a teary-eyed woman was dragged in handcuffs to the lock-up van. She’d been at the receiving end of CS gas and I was asked if I’d check to see that she was ok but the police wouldn’t let do more than actually look through the cage she was sitting in. She was highly emotional but seemed otherwise okay and it was agreed she’d be checked out properly by the Foresnic Medical Examiner (FME) at the police station.

My drunken girl was sitting further down the road with her friends and when I finally got access to the area, I advised her and her friends to get a cab home. She simply wasn’t drunk enough for hospital, which is a twisted irony.


One of the problems I face (as do my colleagues) working on the FRU on busy nights is that I will often spend a long time with patients, sometimes critically ill patients, before an ambulance is available to back me up. Britain’s booze culture is sapping our resources and so, sometimes, you find yourself running out of things to do for a patient while you wait for a free crew. This was the case for my 22 year-old patient who’d suddenly become unconscious in a pub in the East End. A charge nurse from the local hospital had called this in, so I arrived thinking that at least there was one other person inside the establishment who could manage a patient, besides me.

Unfortunately, the nurse was very drunk, very loud and very angry at times. His young friend lay on his side on the pub floor as the manager and bar staff looked on. The place was shut now and the guy had been like this for ‘about an hour’, according to the barman. The barmaid told me he’d had at least five pints but this upset the charge nurse so much that he stood up and launched an angry tirade at her, telling her to ‘shut up’. He told me that the unconscious man had only bought a pint or two. I tried to calm them down because it was getting ridiculous and the nurse had already bitten someone else’s head off for interrupting him as he handed over to me when I first arrived, so it seemed important to me that everyone stayed calm and quiet while I figured out what was wrong with this man. I sensed the delay (sometimes you can just feel it) in getting an ambulance, so I prepared for the long haul.

He was unresponsive, except to deep pain but even then he shut down again after lifting an arm to hit me a few times. He hadn’t taken any drugs and he was a ‘good boy’ who was studying law. I have no idea why that means he’s a good boy and doesn’t do drugs but I took everyone’s word for it and his pupils and breathing rate didn’t say narcotics. So I went for the only possible logical cause (he had no medical history) – booze. He was so drunk, he’d passed out for the duration. His brain had shut down in protest and his liver busied itself trying to rid his blood of excess alcohol. It takes time and his brain wasn’t going to allow him to take in any more while the process was going on.

So, I did all my obs – two or three times and I put a line in and gave him oxygen and fluids. This combination would bring him back to reality soon. I waited for an hour before I saw an ambulance crew – they’d been busy with a shooting earlier, so it was understandable that they weren’t around when I needed them. In any case, the patient was beginning to show signs of recovery and the fluid bolus woke him up as we put him onto the stretcher. By the time he was in the ambulance and I went inside to deliver my handover PRF, he was bright as a pin and laughing at his own jokes, which weren’t funny.

I was thanked by the pub staff and promised that if ever I was up that way I should pop in for free drinks anytime. I resisted the urge to say that I’d seen what the effect of that might be and I mentally declined their kind offer. Anyway, it was pouring with rain and I needed that invitation less than a warm, dry car.


Victoria station is a regular call hot-spot because lots of people get drunk and attempt to get buses home from there. My 28 year-old patient sat in a bus shelter, supported by a small group of men who’d stopped to help him when he fell flat on his face into a puddle, cutting his head open. They propped him up and held his head for him because he couldn’t do it himself, thanks to either alcohol or the head injury...or both. I think both.

Initially he was unresponsive and kept slipping down from the seat he was on. I didn’t want to lie him down in the rain, so I got the posse to continue their sterling work as I put him on oxygen and dressed his wound. The bleeding had stopped and he had a decent gash to his forehead but I knew he’d live to drink again.

The crew arrived and he was wide awake. It had been a twenty minute wait this time, so not too bad and I had everything I needed for a quick handover.


A man was seriously injured later on when he was set upon by a gang and hit about the head with fists, feet and chains. The police were on scene when I arrived and he sat in the doorway with them. His cheek bone and the orbit of his eye were both obviously fractured and his eye stood out from his head like a golf ball. He was a large famed man; about 6 feet 4 inches tall and he easily outweighed me and the police officers around him. Head injuries can produce violent behaviour, especially when combined with alcohol, so we were all very aware of the potential this guy had for damaging us, especially me as I was up front.

He thrashed about a few times and tried to rip the oxygen mask off but he was manageable and I waited no more than fifteen minutes before an ambulance pulled up and helped him to his wobbly feet. I’d dressed his wound and examined him for other injuries, especially to the neck, chest and abdomen, which may have been caused by a weapon (it’s easy to miss a stab wound when you focus on a head injury). He had no other injuries and he’ll recover in time from this one but he may need some reconstructive work done on his face.


I went home on time and the night seemed to have flown in fairly quickly, as busy ones do. The weather was miserable but I was happy enough because I’d done a few good things and had a helping hand and good company for a few hours to boot – it can be lonely out there.

Be safe.

Friday, 23 May 2008

The price of flowers

This is the memorial to the young man who was stabbed to death near Trafalgar Square a while ago. I remember thinking how young he was when I was at the scene of this crime. I also wondered what the cost would be for the family.

Eight calls (including a running call) – one no trace and seven by ambulance.

Theatres are often close, hot places where hundreds, or perhaps thousands of people are packed in like sardines for hours at a time, with one or two breaks, if they’re lucky, between acts. This is a recipe for sudden syncope and so it is not uncommon to go racing off to one of these public buildings to help a ‘collapsed’ or ‘unconscious’ person.

Tonight I went to a couple of theatres; a 60 year-old woman collapsed as she climbed the stairs to go inside the auditorium of the first theatre I visited. It was warm in the bar and she’d got hotter and hotter, so much so that when I touched her head, she felt unusually warm. She’d never fainted before in her life and had no medical conditions but it was wise to get her checked out properly in the ambulance, where an irregular heart beat was found on the ECG, prompting us to conclude that she needed to go to hospital. She never got to see the play, unfortunately.

On this occasion, the St. John Ambulance were on duty but for some reason were not told of this lady’s collapse, so when I arrived, not only did they bemusedly watch me go past with the security guy, the poor lady upstairs had nobody attending to her as she lay flat on the floor with her dignity diminishing.


My second trip to the theatre was for a 38 year-old (although he looked older) man who’d fainted inside the auditorium during the interval. Derren Brown’s show is playing here at the moment and I walked past all of his labelled trunks and storage boxes wondering if he was about to spring out at me.

The man sat in a chair outside the fire exit being nursed by his wife and a member of staff. Generally speaking, theatre staff take very good care of their ill customers and I have always received co-operation and help from them. The same applied here and I was given a detailed handover by the manager. The call had come in as ‘?heart attack’ but the man had no medical history of significance and, from what he told me, he’d simply passed out because of the heat.

The crew arrived and he was taken off to the waiting ambulance – and then hospital – for further checks. As he was wheeled out I told him that it wasn’t happening and that he had been hypnotised by Derren Brown into believing it all. Well, it raised a smile.


Presumption can lead to mistakes in this job and I am no less a victim of it than anyone else, so I must be more careful in future. I was called to an 18 year-old male with chest pain at a large store in Regent Street. My experience of such calls is that I will probably come across a shoplifter who’d been caught, or an individual who simply wants to get away from the place. I’d been given no other details and because we now start rolling to calls before the call-taker has completed the conversation, it’s possible to arrive on scene without all the facts – another minute-saving idea that has not been properly thought out.

I went into the store with everything I’d need for a call but I didn’t take my bag. When I got to the patient, I found out he was a member of staff. He was in the basement and he was suffering a Sickle Cell crisis. That meant I needed to have entonox with me. It’s not something we carry to every call automatically. I had morphine but that would require an IV line and I wasn’t expecting to have the luxury of time to insert one before the crew arrived.

I put him on high flow oxygen and that helped. His pain score, luckily, wasn’t too high and the pain itself was localised to his chest area. He would need pain relief and possibly fluids and without entonox to hand I was at a disadvantage. He’d already had diamorphine earlier at the hospital but it had worn off.

The crew arrived within ten minutes and he was taken to the ambulance, sucking on entonox because they had received all of the information about the patient, unlike me. While he sat there and we exchanged paperwork and callsigns, he became less responsive and when the paramedic asked him to speak he said ‘Are we there yet?’ in a drunken, slurred voice. He had been hitting the entonox far too fast and hard; he was an entonox junkie and that explained why he insisted on the gas rather than an injection of more powerful stuff.


No traces are frustrating because they tie up resources and waste money. My call to a 33 year-old male with chest pain took me to the Strand, where I searched for him to no avail. The crew arrived and they too looked around. The call had been made from a public phone box, so it had obviously been a hoax...or he had changed his mind and wandered off. Luckily for my next patient, this no trace had brought me and the crew to her locality.

I went into the McDonald’s (I know but I was starving) to get something to eat and I had ordered and received it when the manager came up to me and said ‘when you’ve finished can you have a look at this lady here, she’s not breathing too well?’

I couldn’t very well take my meal away, eat it and then go and help the lady and she was sitting forward in her seat, breathing with obvious difficulty, so I went straight to her and asked her what was wrong. She told me she had a history of Pulmonary Embolism and high BP and now she had DIB and chest pain. I checked her oxygen saturation level – it was low.

‘I’m just going to get some oxygen from the car, you wait here’, I told her.

‘Oh, please finish your meal first’, she said.

As I left, I wondered how the headline would read in tomorrow’s paper if I’d taken up her invitation as she continued to deteriorate.

‘Paramedic munches meal as patient dies in front of him’, it would scream.

I’m never going to be so hungry that I’d ignore the needs of an obviously ill person; I’ve even stopped eating to give a plaster out. We are all good guys and girls really.

I went to the car as she sat inside and grabbed my oxygen and other bits I’d need. I called it in to Control and requested an ambulance. Then I returned to find her gone. I looked around but couldn’t see her anywhere. The manager came over and told me she’d gone to the toilet, so I waited outside the door for her like a stalker. She took an awful long time and I considered the possibility of having to unlock the door to get to her.

After ten minutes, she appeared, looking much paler than I’d seen her earlier. The ambulance arrived and the crew, who’d been on the no-trace up the road, took over. By the time she was settled in, she began coughing up blood, so she was quickly taken to hospital.


I went back and got a fresh meal but still had to pay for it.


It’s rare to meet anyone who has experienced cardiac arrest and survived to talk about it. My next patient, a 62 year-old man with chest pain, told me he’d suffered a heart attack and arrested at home just a few months back – he said the pain he experienced now was similar to the pressure he felt on his chest as a result of the compressions that had been carried out on him. He’d been shocked back to the land of the living then and a stent had been placed in his heart to prevent another heart attack but here he was, sitting on his bed, going down the same road. He’d been ignoring this pain for a few days.

He was taken to hospital but wasn’t too keen on the idea. He wanted us to tell him he was okay. He was frightened and I completely understood why.


A 21 year-old girl sat outside a club with her mates and wailed as she tried to breathe properly. Her hyperventilation disguised any sign that her breathing may not be 100%, and this was important because she told me that she had a heart problem and was taking Warfarin. She had a history of blood clots but I wasn’t told what the heart condition was. I took her seriously and, even though she was a little drunk and very emotional (not helped at all by her clawing, pawing friends who wouldn’t keep away from her as I tried to talk), I had to get to the bottom of her problem in case she collapsed on me.

I had her settled and calm in ten minutes and the ambulance rolled up the street to take her away. Her friends took another ten minutes to calm themselves – alcohol induces hysteria in otherwise well-controlled people.


A call to a 27 year-old male ‘collapsed, bleeding ? where’ took me to Trafalgar Square and to a gang of people in a doorway. Three tourists had called an ambulance and they left shortly after I arrived but I was still among five or six drunken men who were non-English speaking in the majority and who didn’t mind getting in my way unless I physically pushed them away from me.

All of the men, including the patient, who was flat on his back completely drunk, were Romanian. When I asked what they did for a living (the patient’s hands were very rough, so I figured they were builders), the only English speaking representative of the group proudly said, ‘we work in black market’.

The man had vomited but that wasn’t going to be the end of his show. As soon as the ambulance crew arrived and took him into their vehicle, he projectile-vomited all over the paramedic’s uniform, repeating his performance over and over again until the floor was awash with the stuff. I popped my head around the door at the precise moment he did it again; I could feel little splashes of it hitting the doors and around my hands. It smelled awful and I wondered what he’d been drinking all night. Whatever it was, it didn’t cost him much and it came by the litre.

Be safe.

Wednesday, 21 May 2008

A fitting end

Eight calls; one pronounced dead on arrival and seven others by ambulance.

Duplicate calls occur every now and again – they used to occur a lot more with the old despatch system but thankfully, in my experience at least, they are now few and far between. This morning, my first call, to a hotel for a 50 year-old woman with chest pain, cost us two ambulances and myself. One of the crews had been given chest pain and the other, abdominal pain – both calls originating from the same place and for the same person but each given a separate CAD number. It was all sorted out when the woman walked out of her room with the first crew on scene. She didn’t even really need an emergency response to be honest.


I got to spend a couple of hours drinking coffee and chatting to my colleagues at one of our regular meeting points in our standby area in Soho. That’s when I noticed a building across the road with one of those blue plaques, you know, the ones that tell us all about who lived or died in a particular place. This one stated that John Logie Baird, the Scottish inventor of television, first demonstrated it in that house. Now that may not seem like a big deal until you think about just how much television has changed life on this planet; it’s one of the most significant inventions ever to have been developed and one which almost every civilisation on Earth is influenced by. What struck me was that he’d been showing off his first telly in a non-descript building in the middle of Soho.


My conversation was interrupted by a call up north for a 72 year-old female. There were no details on my screen, apart from the basics, until I was half-way there; then I was informed that the lady was ‘not breathing, was blue’ and that ‘CPR was in progress’. I raced to get to the little bungalow and I was the first to arrive.

The door to the house was already open and I parked up and grabbed all the equipment I’d need for a resus. The warden, who’s called us, appeared at the door as I made my way over and waved me in. I was directed to a small bedroom at the back of the property, where an ashen-faced woman lay on the bed, face up in her nightclothes. She wasn’t breathing and she looked like she’d suspended a while ago.

‘I’ve done about 400 chest compressions but no breaths’, the exhausted looking warden told me.
‘How long has she been like this?’ I asked him as I started going through my checks.

‘Since 9 o’clock’, he said.

It was 9.15 now and if he was to be believed, he’d given his compressions at a rate of about 25 per minute – a quarter of the rate needed. Still, I wasn’t there to judge the man and he was clearly confused, given the situation. I had to assume that his information may be incorrect and, even though I sensed the lady had been ‘down’ for a while, I decided to continue with CPR. First of all because there was legitimate doubt about the timing of arrest, secondly because the lady was warm and flaccid with no absolute physical signs of death and finally because the warden had already started the attempt and so, morally I guess, I was duty-bound to complete it.

My colleagues from the ambulance arrived just as I was attaching the defib pads and planning a way of getting her from the soft bed to the floor. She was a large, heavy woman, so it took all three of us – myself and the crew – to move her into a position where CPR would be possible. After that, it was a case of getting into a well-rehearsed routine; compressions, ventilations, IV access, drugs, intubation, attaching the automatic ventilator (which almost pulled the tube out again), more drugs, fluids...more drugs...BM checks...more drugs...and no shocks. The woman was asystolic throughout.

Twenty minutes later and we could have called it but we didn’t. We got her out of the house and into the ambulance. Her neighbour was wandering about outside and attempted to get involved in our efforts while her friend was lying lifeless on the floor. I had to walk her back out in an almost catatonic state when she realised what was happening.

‘Is she alright?’ she asked me, her eyes staring past and over my shoulder to the scene in the bedroom.

‘No, she isn’t I’m afraid’. What else could I say?

She was an awkward lift-and-carry; a lot of them are but at least we were on the ground floor, so we got her into the chair and wheeled her outside and onto the trolley bed, which couldn’t fit inside the house. She was taken into the back of the ambulance and I handed over clinical lead to the paramedic on board, who was happy to continue. More drugs, capnography and no shocks still.

We ‘blued’ her in and the efforts continued all the way to hospital but it was called within ten minutes of arrival and she was left, covered up, in Resus while a young family sat around their ill granny in the next cubicle.


After that call, I was out of action for a while, replacing equipment and cleaning up – suspended calls are messy affairs.

Then I got a call for a 25 year-old female who’d fainted at an underground station but I wasn’t required because a crew was on scene as I arrived. Well, I thought I wasn’t required but as the crew investigated the circumstances of the woman’s syncope, questions about her health began to arise and I stuck around to look at her ECG, which appeared to show a prolonged Q-T interval. She fainted a lot, apparently and so the initial thought of letting her get on with her day was abandoned in favour of caution. Her BP hadn’t fully returned to normal anyway.


A 29 year-old security guard who dialled 999 claiming that he was ‘vomiting blood’ had chucked up what I can only describe as alcohol-stained bile; a brownish, yellowish watery substance. It waited in a waste-paper basket for my inspection when I arrived at his place of work (ironically, he has a bank of CCTV monitors on the wall covering all of the outside and street area but he failed to see me at the door, so I waited for five minutes until he appeared).

‘That’s not really blood’, I told him. He actually looked disappointed.

‘It tasted like blood when it came out’, he said. Maybe he hoped he was sick enough to get off work.

‘Well, maybe you’ve vomited so hard that blood has come up from your throat’, I suggested. I was attempting to calm him but I could sense he also wanted validation for his need to call an ambulance.

The crew arrived and, after a quick handover, he was taken away. The building now sat completely unsecured.


Another sleeping drunk required an ambulance after a MOP called us because he or she thought the 55 year-old man was unconscious in the street. He was taken to hospital so that he could sober up and continue his slumber in peace.


A 40 year-old man sat outside a shop with a passer-by attending to him when I arrived on the call for ‘DIB’. In his case, it was more the sudden dizziness and palpitations that he was experiencing that concerned him. He’d had a viral infection recently and this could be the cause of his current problem because he was normally fit and well but it was prudent to check him out properly – very often cardiac problems manifest in these small, subtle ways.


Two fitting patients for the price of one next – both on the same street and both within a few minutes of each other. I was called to the first, a 26 year-old female, who’d had a seizure for the first time for a while in front of her friend. She was post ictal when I arrived and she became very, very upset and distressed when she began to realise what was happening. The MRU arrived a few minutes after I did and we waited with the woman in the busy street, as she attempted to make sense of her world. She’d lost bladder control and as soon as she realised that, she cried even more.

Some epileptics recover slowly into a frightening, confusing sea of strange faces and environments and it’s important to help them stay calm and maintain emotional stability until their brain works everything out – it’s a bit like waking up in a strange room and not knowing where the hell you are or what day it is. It was useful to have her friend there because she was the only recognisable face around for her.

The ambulance arrived after a while but when I began to give the crew a handover, they told me that their call was for a 30 year-old male, not a 26 year-old female. Even the CAD numbers were similar but it was clearly a different call. Now that they were on scene, however and given the distress of the lady in a public place, it was agreed via Control that the crew should stay put, rather than continue, which would make us all look bad.

I left them to it and ‘greened’ up so that the other epileptic call could be sent down to me. I would go there and do what I could until an ambulance arrived, so I sped off down towards the other end of the road and found the patient slumped near a doorway. A CRU paramedic was already on scene and I could hear the wail of an ambulance not too far away, so I asked if I was needed – I wasn’t. The patient was an alcoholic, so it probably wasn’t epilepsy.


Be safe.

Tuesday, 20 May 2008

Death by bread

Ten calls; two assisted-only and eight by ambulance.

Well, not exactly death...but a serious enough wound that could have been a lot worse and even potentially fatal. This was my third call of the morning and I had just bought myself a nice warm bacon sandwich. A 30 year-old female had cut herself on a knife and blood was ‘squirting’ from the palm of her hand, according to the details on my MDT. My sandwich would have to wait and I knew because of the distance I was being asked to run, that it would be cold when I got back to it. My stomach would rumble all the way through this call.

I arrived at a delicatessen (and that seemed like a wind-up, considering my bacon sandwich sat, unloved on the seat of the car) and was guided downstairs to the basement, where food is prepared for serving to the customers above. A Pale, sweaty woman sat on a chair, holding her bandage-covered hand up in the air whilst a colleague (the owner’s daughter) tended to her. The wound was covered by a flimsy paper triangular bandage, not a dressing as it should have been, despite the fact that the first aid box was open and contained plenty of sterile dressings.

Then I heard the incredible story of what probably happened. She’d sliced her hand open, down to the deep muscle at the small finger but the knife that had initially been blamed for the wound was clean. Blood was spattered all over the sink area and could be seen on the floor around her but not a drop was on the blade of that cutting tool. So what had done the damage?

It turns out she’d slipped and fallen whilst carrying frozen crusty bread (defendant above). This stuff is lethal enough inside your mouth when it’s thawed and I could see how a frozen, jagged loaf could easily cause a deep laceration to soft tissue. Luckily the pointy bread hadn’t cut through an artery or we may well have had a serious problem, especially as the owner of the establishment had no idea how to use his first aid kit properly (it’s a legal requirement). She could have bled to death as a result of her brittle mishap if her carotid had been taken out.

I dressed the wound, elevated her hand in a sling and advised the owner about his first aid issues. Then the crew arrived and I showed them the photo (I take these with the patient’s permission and to serve as a record for the crew after I’ve covered the wound up) – they were stunned that bread could have caused so much damage. It was a rare call, that’s for sure and I doubt I’ll see many more injuries of this nature caused by floury products!


I’d started my day off with a call to a 40 year-old man with chest pain and DIB but I wasn’t required because a crew was on scene when I arrived and I got taken away from that call immediately for an 83 year-old man ‘? TIA’. He was living in a very posh residential care home but it was awkward to get to as the entrance gate was padlocked and nobody came to meet me. The ambulance drew up alongside as I called Control and the crew managed to find another gate further away, so I went on foot and walked beside the vehicle as it headed to the main building, a large Georgian house.

The man was in bed and a nurse had called us because his behaviour had suddenly changed; he was confused and pale. He had a history of CVA and when I checked him I found his pulse to be slow at around 43 per minute. The crew quickly took him into the ambulance, where an ECG and other tests were carried out before he was ‘blued’ to hospital.


A 65 year-old man who worked in a club in the West End called an ambulance for his dental pain because his emergency dentist was unavailable. I know the agony of toothache but I wouldn’t call an ambulance. He decided to add ‘chest pain’ to his report and that got him a 999 response. He may well have had both because of the stress the painful tooth was putting him under and so he was given the benefit of the doubt, as would anyone, and taken to hospital on that basis. His ECG was absolutely normal.


A pale, shaky 35 year-old man was hit by a lorry as it turned into a street. He hadn’t seen it because the roads were closed off for emergency gas repairs, causing chaos for traffic and for me when I tried to get there. He’d assumed nothing would be travelling along it, so he got a shock when the truck knocked him off his feet and into the road.

His family were with him because he’d called his wife when it happened, after picking himself up and staggering back towards a car dealership (which he was on his way to visit). He was inside when I arrived and looked very out of sorts, as you’d imagine. Although he only complained of a minor pain in his leg, he was a bit vague and had also bumped his head on landing, so I advised him to go to hospital, despite his reluctance to do so. The crew added a bit more persuasive pressure and he eventually relented.


Brittle asthma is an unpredictable danger and my next patient, a 38 year-old woman, was suffering an attack, even though she’d used her home nebuliser. She sat, leaning forward in the classic asthma attack position, on her sofa as her children watched telly. She’d been to hospital many times and it was obvious she was in danger if her breathing wasn’t corrected quickly. I put her on my O2 driven neb and she began to feel better by the time she was taken to the ambulance. I’d had time to do a peak flow and her PEFR was 40% below normal, which is significant.


Stubborn elderly people, especially men, with SOB are usually genuine cases that need to go to hospital but try and try as we did, the crew and I could not persuade this man that he was ill. His daughter had called us and when I arrived he simply said that he was ‘fine’. I put him on oxygen and he felt better than ‘fine’, conceding that his breathing was being helped. He still didn’t want to go and asked if we could just leave him on the oxygen at home. Of course, we couldn’t and he was waiting for his GP to get him a home oxygen system, so we argued that corner for a while.

Just as we were leaving (I’d taken him back off the oxygen) he felt a little worse and shouted out for us to come back because he was, after all, going to travel to hospital. We weren’t happy about leaving him anyway but his earlier insistence gave us no choice. Taking the oxygen off him had proved that he couldn’t do without it and he’d relented.


I rushed out into the rain for a 31 year-old with DIB which was brought on ‘after an argument’. I knew I’d probably be looking at hyperventilation but stress brings on many, more serious conditions. She was sitting inside a cafe and her friend, who’d started the argument, was trying to calm her. She was breathing way too fast and all the associated symptoms were making her feel worse. I spent twenty minutes calming her until she felt fit enough to carry on her journey, friend in tow.


Then a Red1 to a bus parked near Oxford Street for a 16 year-old ‘foaming at the mouth; unsure if breathing’. I felt sure myself that this wouldn’t be as given and I also knew there would be a LOT of fuss for this call. I turned up and boarded the bus. Three managers and the driver were present and they pointed to the back seat in which slumped a man, much older than 16, who was most definitely breathing. In fact, he was sleeping.

None of the guys on board dared to get near enough to him to establish his problem and now I was shaking him awake, much to his disapproval, as the police, MRU and ambulance turned up.

‘You need to get off this bus please’, I shouted.

‘No!’ he shouted back in my face.

‘Okay then the police will move you off’.

I met the officers at the door, explained the problem and one of them made it clear to the man that he was getting off or being arrested. He chose to do the sensible thing and walked off the vehicle as the sheepish bus driver and his managers stood by.

The new mayor of London has pledged to make it an offence to drink alcohol on buses and expects the drivers to enforce it. How is that going to work if they won’t even try to wake up a sleeper for fear of bodily harm? We are going to be used even more to do their jobs. Boris really has to think this through properly...oh, and while I’m addressing him (‘cos I’m sure he reads this!) – can NHS staff have free travel on public transport (like the police do) and exemption from the congestion charge, please?


It all ended with a 28 year-old pregnant woman with a cough. The call was given high priority because she told us she had (can you guess?) ‘chest pain’. The crew arrived soon after I did, so I left it to them because, quite frankly, she was producing pathetic little burps with no wheeze or rattle of any kind and my cat, Scruffs does that when he’s playing sometimes.


Be safe.

Monday, 19 May 2008

Good intentions

Eleven emergency calls – one no-trace, one treated on scene, one assisted-only and the rest went by ambulance.

No time to complete my VDI before this call for a 65 year-old man, fitting in the street. Bearing in mind that it was a Friday morning and the Thursday night human detritus from binge boozing would be scattered on the pavements ‘fitting’, ‘unconscious’ and ‘vomiting’ just as the sober general public would see them...thus the 999 calls. Obviously, I went to it on that basis but with some thought of the possibility that it may be genuine.

It wasn’t. I drove up and down the street looking for him but he was nowhere to be seen. The caller had left the area and the patient had probably staggered off home.


I completed my VDI and set off for my next call. A 39 year-old man was having a fit. He was diabetic, so it sounded like he was probably hypo...time would be of the essence but it was a long trip to Knightsbridge, which is way out of my working area.

The crew were pulling up at the large department store, where the patient apparently worked, as I made my way around to the back to meet them. We had to walk some distance to get to the man, who was laying on a sofa in the canteen. He was barely conscious and looked very ill. His BM was 1.9 – far too low, so we gave him an injection of Glucagon (giving him anything by mouth would have been impossible) and waited for it to take affect whilst we completed the rest of our obs and gathered information about him and the circumstances of his current state.

He was a night security guard and had been on for twelve hours, so it’s possible he’d simply run low on blood glucose during his shift and hadn’t realised the threat it was becoming. He was found collapsed by his colleagues.

Ten minutes after giving the Glucagon, he began to respond and his glucose level was supplemented with Glucogel, given orally. He was a perfectly passive, non-combative and completely submissive hypoglycaemic. We had no trouble treating him. He was one of a rare breed.

It took twenty minutes for him to recover and his BM rose to 3.5 in that time. Further treatment arrived in the shape of a sandwich and drink and I left the crew to it as I made my way downstairs and along the lengthy corridors to my car, wishing I had a sandwich and a drink.


I went back to my station and had a cup of coffee with my MRU friend. The lull lasted a short while then a call came in for a 30 year-old male who’d scalded his face. The completely wrong location was given and me the MRU circled the location like buzzards looking for a meal until we were re-directed to a spot just down the road from the station we’d just left. The patient and his friend had seen us go past on the call but hadn’t windmilled us, so obviously we ignored them.

He had scalded about 10% of his face on steam from a high pressure vent and we found him sitting on the pavement waiting for us. Burns are time-critical because without cooling they will travel deeper into the skin tissues. He must have sat there for ten minutes listening to our sirens a few hundred yards away, while his burns developed across his skin, producing blisters.

I put a Watergel dressing on his face and waited for the ambulance to take him away. The crew had also been sent to the wrong location but were re-directed on our instructions to the correct place. The confusion was caused by the patient’s friend, who’d called us and given the wrong street name.


Out again with my MRU colleague to attend a 35 year-old woman who’d collapsed with ‘?TIA/stroke’. She was inside a University building near the station and she was completely distraught.

‘Something’s not right‘, she kept crying.

She’d been lecturing when one side of her face suddenly became extremely painful and she lost control of her speech. She also complained of numbness in her arm on the same side. It’s possible she was suffering a TIA but it’s also possible she was experiencing Trigeminal Neuralgia – isolated or as the result of a TIA. There was no discernible palsy and she had been given no warning (headache, etc.), so she was very, very frightened by this sudden change. TN affects many people, especially women and in her case, it’s a shot in the dark but it was necessary to keep her calm, so a suggestion that it may not be as serious as she thought was very useful in keeping her under control until the crew could take her to hospital.

She was a lot quieter when she was in the ambulance and I hope, for her sake, that they found nothing too damagingly wrong with her when she was examined by the doctors.


My next call was for a homeless man who’d been found ‘unconscious’ in the street, although the caller hadn’t actually gone near enough to him to establish that fact. I guessed he’d be sleeping off his booze and when I arrived, with the MRU, I gave myself an imaginary ‘well done’ button. He was asleep and he woke up within five seconds when I started to shake him.

The man had nowhere else to sleep and had been on the streets for four months. He was nice enough to me and I suggested referring him so that he had a roof over his head. He was glad of the help, so I called the number we have for London Street Rescue and sorted it out; someone would come and check on him and get him food and shelter, so long as he behaved and didn’t get drunk. With most of them that’s an unachievable aim and they end up back on the street.

An ambulance had also turned up by now but I had already done what was needed and the man was slumped against his wall with a blanket (courtesy of the LAS) over him. I’d asked him not to go to sleep because people would call us out again but he lapsed back into his coma as soon as I’d left him. The blanket would stop people dialling 999 because it advertises the fact that the person underneath has been attended to recently – that’s not always true but at least it calms the panicking public.


A 48 year-old woman with an enlarged heart called us because she had ‘chest pain’. When I arrived and the crew parked up behind me, we found her in the first aid room of her workplace; the lights were off and she was flat on her back – not really the correct treatment for chest pain.

She was complaining of a sharp pain in her neck which came on every time she moved about. Her history of enlarged heart made this a suspicious development but there was no chest pain at all and never had been, so why it appeared on the call descriptor, I’ll never know.


Traffic was building up wildly on the main route to my next call, for a 74 year-old woman with DIB. It was so bad that I had to use the pavement to negotiate my way to the scene, only to find that the address didn’t seem to exist. An ambulance crawled towards me as I searched for it on foot and I called Control for a better location. The crew went in the opposite direction, across the busy road and through a building site (again on foot) and they found the address there a few minutes after they’d left me, so I was stood down and went to do my paperwork. The patient was stable, apparently but had she been in critical condition, the traffic, the roadworks and the messy building site that obscured access to her address would have cost her dearly. We were activated in plenty of time and I was on scene within 8 minutes but the location delay meant another ten minutes slipped past before she was reached.


I was sent into the City for a 30 year-old who’d fainted. It was long, traffic-laden drive for nothing because a crew was arriving as I pulled up on scene.


A 40 year-old Polish man had been seen slumped at a bus stop, so we were called and the police were activated, just in case he was dead. He was, of course, drunk and asleep. It took a few seconds to bring him back to life and I hauled him upright to prove to the watching world that he was a costly sleeping visitor and nothing more. The police moved him along...at least they did eventually because he initially refused.

‘Hospital?’ he’d ask, looking at me and then over my shoulder for signs of an ambulance. He wasn’t in luck because I’d already cancelled the ambulance.

‘We’re not a taxi service. There’s nothing wrong with you but alcohol, so NO, we’re not going to hospital’, I informed him.

This came as a shock I think because he genuinely didn’t believe me. When he came to his senses, he staggered off in a huff.


I’ve never been on the London Eye, either as a tourist or at work, so my next call, for a 33 year-old female ‘fitting’ on the Eye meant I was going to step onto it for the first time. To be honest, I’ve never really been thrilled at the thought of going around in a big, slow circle to see the tops of buildings I already know exist.

A crew and MRU were on scene and I joined them to assist. The capsule hung over the river and the view straight down through the floor was awe-inspiring. The patient was lying on the central bench and was recovered from her episode. The MRU had been first on scene and was competing his obs. All I had to do was a BM and assist the crew with their exit from the wheel because the management were anxious about the length of time the long queue of tourists were being made to wait for the world’s slowest hamster ride.


My last job of the day was for a 32 year-old male with chest pain. A MOP was helping him as he sat in the street. He had no previous history for cardiac problems or anything else for that matter and he looked perfectly normal to me – no DIB, no diaphoresis, good vital signs, normal ECG...but the crew took him to hospital because chest pain is chest pain and a persistent pain is ominous. However, if you believe the new advertisement that’s plastered on almost every bus in London, you’ll be calling for an ambulance every time you get a stitch because ‘It’s your body’s way of telling you to call 999’. Now, I’m not getting political with the BHF and the ad is supported by the Ambulance Service Association AND plenty of people mistake their chest pain for indigestion, etc. but I really think this ad has been badly thought out. It’s aimed at the minority of people who’d probably not call an ambulance because they didn’t recognise the signs or symptoms or are too stubborn to believe they are having a heart attack (like me, for instance), but I think it will generate a flood of calls from people who don’t actually have true chest pain but who’ve seen this ad and will react accordingly. We are under enough pressure as it is, so the consequence may be that an increased workload will distract us from the genuine cases...it’s an untidy catch 22. Plus that’s a HORRIBLE picture.

Be safe.

Saturday, 17 May 2008

Panic in the city

Eight calls; one dead on scene, one false alarm and six by ambulance.

A naked man lay dead by his bed with a tray of cups scattered around him. He was found by a neighbour who reported the 78 year-old as possibly deceased. He was stiff and post mortem staining was obvious, so the neighbour's description was accurate. A crew and MRU were on scene but all we could do was fill in the paperwork recognising life extinct and leave it to the police.


A RTC next and a 25 year-old male, who’d been hit by a car, waited for us with a minor head injury. Again a crew and MRU were already on scene, so I wasn’t really needed and I greened up for the next call, which was for another 25 year-old, this time a female, who was ‘shaking and feeling faint’. The crew was on scene with me and the woman wasn’t shaking and didn’t feel faint – she just wanted an ambulance because she didn’t feel 100%. I left the crew to it.


A call to Regent Street sounded like a psychiatric case; a 35 year-old man had collapsed in the street and was banging his chest as if in pain. Passers-by, who genuinely worry about such things, called an ambulance for him but when I arrived I found a CRU paramedic on scene with a younger man, probably about 20 years-old, who was hyperventilating. His female friend was having an asthma attack and both had collapsed in a heap after running frantically to meet an exam deadline (it’s that time of the year for students). He panicked and she sympathised with a genuine illness. I requested another ambulance for her and both were taken, separately to the same hospital. Both would miss the exam after all, so their distress was fruitless.


Another case of panic but with the addition of some amateur dramatics, was my call to a 34 year-old female ‘? Fit’ in a ladies’ toilet. She was lying on her back, eyes closed tightly, feet thrashing about in a feigned display of epilepsy. She’d suddenly dropped, according to her colleague, bashing her head on the wall as she fell. Then she lay there waiting for me to come and make her sensible again.

I persuaded her to stop kicking and open her eyes and she told me, eventually, that she was worried about personal problems. She had fallen down in an attempt to make her despair clear, rather like a child does when they are having a tantrum – throwing themselves to the floor.

The crew took her to hospital but all she really needs is an adult way of expressing herself in public.


I had to find a needle in a haystack on the next call – well, a coach among dozens of them parked up and down the Embankment. It’s not an easy task when it’s for someone with chest pain and the only thing you have to go on is that it’s ‘blue’. There must have been ten blue coaches along the route on each side of the road. I drove, turned around, drove some more – looked into each coach, turned around again...it was almost comical.

Then I found it. The driver was sitting on the pavement complaining of chest pain. He was 27 years-old and from Albania. He had a coach full of tourists who were on their way to catch a flight from Stanstead airport; some of them were on the pavement too, confused and bemused at the same time.

He had developed the pain whilst driving and told me he hadn’t been sleeping well, hadn’t eaten well and was generally run-down. I knew that feeling; I’ve been the same myself for a few weeks recently. His pain probably wasn’t cardiac related but we waited for an ambulance because you just never know – even with a clear ECG.

I went aboard the bus once I had made my patient comfortable and asked the passengers if they’d like to get some fresh air. It was very warm inside the vehicle and there were children sitting there with their parents. A replacement driver had been called out and he arrived within twenty minutes, along with the ambulance. The driver was taken to hospital and the tourists got to continue their journey to the airport.


A bizarre call next for a male prisoner who’d set himself alight on a prison van during his short trip from court to a cell. He’d smuggled a lighter on board and attempted to go up in flames, along with anybody else in the vehicle by putting the flame to his shirt. Luckily, his shirt didn’t burn too well and the driver and guard put him out with water before he could become a human torch and a martyr to the incompetency of the prison transfer system, which I assume, searched him. The police had closed the roads off and were there in force – one officer even brandished a riot shield but when they took him off the van and surrounded him, I realised they were probably over-reacting. He was a skinny, sheepish looking individual. I thought maybe there were five or six murderers on board who’d come out too but he was the only person in there. Ten cops, an ambulance, MRU and FRU – all for a shirtless man who couldn’t even stage his own suicide properly.


My day of panic attacks ended with a 26 year-old man who’d passed out after hyperventilating. He was in the first aid room of his office with colleagues attending to him. He had a history of panicking and he sat on the couch trembling like a leaf for no reason (or none that he would give me). The crew took him to a softer, gentler place to recover and I went back in preparation for going home...and this time, they let me.

Be safe.

Friday, 16 May 2008

Losing battles

Seven calls; one refused, one conveyed in the car, one pronounced dead on arrival and the others by ambulance.

The first hour of the shift, early morning and I’m just waking up after a cup of coffee but the dead and dying care not for my creature comforts. A 60 year-old female is unconscious and not breathing. It’s a Red1 and my update tells me that ‘CPR is in progress’. I get on scene first and run to the flat in question. A nervous, drawn man greets me at the door; ‘I think my wife’s dead’, he says with high emotion. I walk in to find her lying face up on the bedroom floor. CPR is not in progress.

The room is very small and cluttered, making life difficult for me and I could tell it was going to be an awkward job when the others arrived to help. I set up the AED after carrying out my basic checks, although it was obvious she was in cardiac arrest. No shock is given because she is asystolic and her heart is receiving nothing from her brain. She looks like she’s been dead a while but I can’t be sure; she’s still warm and flaccid, so I start CPR.

The crew arrive as I begin and they quickly fall into the well-rehearsed and well-practised routine for this situation. We work on her for twenty minutes in that crowded little place and her husband looks over our shoulders from the hallway. I can see grief and acceptance of the inevitable on his face but I still tell him we’ll do all we can and that she can’t feel anything we’re doing to her. I may be lying when I tell people the last part.

I give all the drugs I need to and we decide to continue all the way to hospital. Her BM is low and it drops throughout the effort, despite Glucose. She’s had cancer and her Liver may be affected by it, so it’s possible that organ failure was the primary cause of her arrest.

Another crew turned up half-way through and now we plan to get her out of the room and into the ambulance. It will be an awkward, heavy lift-and-carry all the way down the stairs, so a scoop stretcher is used and four people – one at each ‘corner’ – have to bear the weight. At times, I think she's going to slip off onto the stairs as we heave and balance on each step.

CPR is still in progress and we continue our care in the ambulance – I give more drugs and she is being aggressively resuscitated. Twice the AED reports that a shock is to be delivered and twice it cancels – she’s not coming back.

They try for another ten minutes in Resus but the towel is thrown and they call it.

The husband didn’t come with us – he told us he’d be along later. I wondered why he would want to stay away. If she’d come back, even for a short while, he may have been able to hear her voice for the last time. He’d gone to sleep with her and woken up the next day to find her lifeless beside him. I wonder what they said to each other before they went to sleep.


It took me almost an hour to clean up and replace my stock after that call. Luckily, there was no need for me to go back and get my car because one of my colleagues volunteered to drive it to the hospital while I stayed in the back of the ambulance. Once I’d freshened up again, I was off to a male ‘fitting’ at a building site. The 17 year-old was post ictal; very confused, pale and sweaty when I arrived and a CRU colleague was treating him. A crew was on scene shortly after I arrived but I thought it prudent to get IV access, so I put a cannula in his arm just in case. His BP was very low and hadn’t come back up after his seizure – he may have needed fluids.


Traffic has been very bad this week and my next call, to a 36 year-old male, diagnosed with peritonitis and having abdominal pains, had to be conveyed in the car. No ambulances were available and even if there was one nearby, it would have taken forever for it to get where I was, so I called Control and let them know I could take this one myself. He was stable and agreed to be taken by me rather than wait for another vehicle.


A 46 year-old chambermaid (do we still use that term?) had been vomiting and suffering from diarrhoea for three days but only just decided, during work, to call an ambulance, so I was sent to check her out. Although she said she was vomiting ‘all the time’, at no point during my twenty minutes with her prior to the ambulance arriving, did she demonstrate this. Quite frankly, she could have walked or taken a taxi to hospital because it was just across the river.


Into the West End for a 20 year-old who called from a phone box complaining of chest pain. Cardiac pain is unlikely (not impossible) at that age, so I didn’t think I'd be treating him for an MI. He walked to the car when I arrived and told me that he had pains in both sides of his chest when he breathed – especially when he breathed in. He had a history of bronchitis and asthma and when I listened to his chest, a slight wheeze and a bit of a rub was evident. I put him on a neb in the back of the car while I waited for the ambulance.

I waited for half an hour and in that time, I learned the young man’s life story. He seemed plausible and likeable but there was an edge to him that made some of what he told me untrue – he said he was doing a degree in physics, which I though was admirable. He was chasing a career in forensics – again, commendable.

The crew turned up and took him away and later on I was told that he was a drug addict, living in a hostel. I am quite gullible sometimes – ask anyone who knows me.


My MDT refused to show me the next call, even though my service mobile had beeped to warn me that one was coming, so I took the details the old fashioned way over the radio and planned my route to the job using a map, instead of the navigation system. This takes a few minutes (as it always did in the old days) and by the time I got on scene, an ambulance and MRU were already there. No need for me then.


A bus allegedly knocked a cyclist off his bike and he sustained a graze to his leg – nothing more. He refused an ambulance when offered one by the bus driver and his manager, so the manager wrote ‘no injury’ on his report form. When the cyclist saw this, he changed his mind and demanded an ambulance, so I was sent. The incident had taken place more than thirty minutes before.

When I arrived, all I got was an earful from the patient. He complained about the bus driver’s behaviour and about how he’d tried to kill him. I stayed neutral. I asked him if he wanted to go to hospital and he said no. I called the police because someone had to deal with this and it wasn’t a medical matter. I positioned myself away from the grazed-leg man and waited for the police while I got on with my paperwork. My MRU friend showed up to assist, although within a short time he too was positioned out of complaint-range of the man with a bemused look on his face.

I was due to go home and I’d had enough of the patient’s moaning, so I took my leave and left him to work it out with the police…if they ever arrived.


Earlier, as I drove to the peritonitis patient, I saw a cyclist standing in the middle of a busy road, attacking a car with his helmet. He bashed it on the roof and window of the driver’s side again and again, shouting expletives as he did so. He may well have had a genuine reason for being angry at the driver – maybe he’d been cut up and bumped by him – but a grown man should never lose his temper to the point where he behaves like Basil Fawlty in broad daylight!

Be safe.

Thursday, 15 May 2008

Balconies are no fun

Eight calls; two false alarms, one treated on scene and five by ambulance.

Allergies to penicillin are common and my first patient, a 32 year-old woman with this problem was given amoxycillin by her doctor. Unfortunately, her body didn’t like that either and her face and hands puffed up in protest. She was stable otherwise but needed to go to hospital for antihistamine treatment.


Then a call to a ‘building collapse’ which was subsequently cancelled and reinstated just in case there were people trapped inside. The building, a shop in Oxford Street, hadn’t actually collapsed at all – a balcony overhanging the pavement had started to fall apart and a large chunk of the bottom part had fallen onto the street without warning (see photo). There were no casualties because luckily, nobody had been walking underneath it when it came down. Plenty of fire appliances had been called to the scene and I was impressed by the array of equipment that the LFB had at their disposal for such an occurrence. I waited with a crew in case the danger increased but the rest of the balcony remained where it was, hanging precariously from the wall of the building.


The British ex-champion boxer Chris Eubank was driving around London in his big rig truck today and I caught sight of him as he went past the British Museum. He frequently sounded his horn so that people would turn around and recognise him – he loves that sort of attention and is famous for doing it in Brighton, where he lives. On a street full of tourists, it was unlikely anyone would smile and wave, however, so he moved on to more familiar territories for adoration.


I went back to the British Museum later on for a 6 year-old female who was ‘reacting to food’. She wasn’t and her parents had simply panicked because she spat out a piece of sandwich that she obviously disliked. Her screwed up face and violent dismissal of the food led her Italian parents to believe their child may be dying. My MRU colleague reassured them that this wasn’t the case and we left the scene.


A 38 year-old private taxi driver had a collision with a bus on Aldwych and I arrived first to find him sitting in the driver’s seat with neck pain. That meant I had to sit in the rear seat behind him and hold his head still until others arrived to help me. He had two passengers on board and, after checking they were okay, I sent them out onto the street to wait. It didn’t take long for a MRU to show up and assist. A crew followed a few minutes later and chaos developed as the traffic began to snarl up in the lane, which was blocked by the car, the bus and the emergency vehicles.

The driver was collared and slid out onto a board through the passenger door. It takes a few of us to do this effectively, so a bit of time was spent planning it properly before moving him. I think he was suffering nothing more than minor whiplash but all the usual precautions were taken with him and he was conveyed to hospital within 30 minutes of his crash.


A run to Elephant & Castle in the south for a 71 year-old woman with chest pain which developed as she entered a bingo hall for a bit of light gambling. I arrived to find members of staff from the establishment chatting to her as she sat in a wheelchair. I still don’t know if it was her wheelchair or it had been provided as a first aid tool. The pain had gone by the time I got to her and she was taken by ambulance to have an ECG done.


Small parks are ideal places for drug addicts to get together for breakfast or lunch…or whatever and one or two of them are ambulance magnets. Sometimes the addicts fight among themselves and I was called, along with my MRU colleague, to an altercation I which a 40 year-old man had allegedly been assaulted by four or five others. His head had been stamped on a few times as he lay on the ground after his initial beating and this had all been witnessed by other drug addicts in the area. So, reliable witnesses then.

The man had a bruised head and was heavily drunk (or drugged), so it was difficult to make an accurate assessment of his state of mind and he was taken to hospital, even though he seemed less than keen. His dog was left with a fellow heroin lover, which was a relief because it wouldn’t stop barking as we poked and prodded its master.


I was on top of the next call, for a 35 year-old male having a fit at a bus stop, when I was cancelled within sight of the patient because a MRU was apparently on scene. I couldn’t see one, so I carried on and let Control know I was there. The invisible MRU was nowhere to be seen, so I got out of the car and went to the patient, who was lying on the ground after having a witnessed seizure. There was a family of tourists dealing with him and I could see he was post ictal; confused and agitated. An ambulance arrived 3 minutes later and by then he was a little more lucid, although he refused to have an oxygen mask put over his face, which is common enough.

We found out that he was epileptic and that he hadn’t fitted for some time. His sudden collapse had scared the crowd around him and I was glad I’d stopped instead of carrying on when I received the cancellation – they had all seen me arrive in the area and it would have looked negligent to have continued on when there was nobody else there to help. I found out later on that the MRU had been diverted en route.


I’ve never wondered how fire-eaters get trained but I stumbled across what looked like an ad-hoc lesson going on in an alley in Holborn. A number of people were gathered around an ‘instructor’, who was showing them how to blow flames from their mouths. It was a strange and interesting thing to watch and I guess they must have thought I’d arrived on stand-by for their benefit!

While I watched I was sent another call for a 50 year-old man who’d dialled 999 from a callbox at the tube station just up the road. He’d developed a headache. Its easy for cynicism to kick in when you get a call description like that, especially when it comes from a callbox at a station notorious for being the origin of nonsense calls, but when I arrived it evaporated because the Italian man’s family explained that he was normally fit and well but had suddenly complained of a left-side headache which was increasing in severity and was making him feel quite unwell. He genuinely looked worried about what was happening to him and a TIA can never be ruled out, so an ambulance was called and he and his little family group were packed into it for the short trip to hospital.


It was a fair shift with nothing much going on I have to say and it ended with a 13 year-old boy having an asthma attack on an estate in the south. The crew were on scene just after I arrived and we went up to the flat together. The boy was mildly asthmatic and hadn’t replaced his inhaler, even though a prescription for a new one had been provided a while ago. The crew knew him and had dealt with a more severe attack earlier in the year, so he hadn’t actually learned anything from it. If you’re genuinely asthmatic you should always carry your inhaler and replace it when it's running low.

Mum had about a hundred kids – they were everywhere. Well, they were either all hers or she was hosting a party for every kid on the estate, so the little flat was busy with tiny people coming and going. I left it to the crew and returned to the car for my trip to off-duty land and home. It was the end of another warm London day and it was my last shift for a couple of days, so I wasn’t in a rush.

Be safe.

Tuesday, 13 May 2008

Choked

Seven emergency calls and two running calls; one assisted-only, one taken by police, one sent by taxi, one conveyed in the car, one refused and the others by ambulance.

Morris dancers, seal-clubbing protestors, anti-this and anti-that groups – Trafalgar Square was a very busy place today. The sunshine helped to make it pleasant, even though some of the characters that came out of the woodwork to put themselves on display didn’t. Who is that sad man, who drapes himself in a Union Jack, dons a builder’s hard-hat and plays cricket with himself against the wall of the National Gallery? Is he some kind of representative of the great British sporting tradition? If not, he needs to go and get himself a job.


An eight year-old girl was fitting, so I was sent to help her but a crew were on scene and I was not required. I was required, however, for the usual time-wasting type of call when a 25 year-old man was reportedly found collapsed in a doorway. He was, in fact, asleep. He is a frequent-flyer of the highest calibre and crews continually pander to his demand to be taken to hospital for absolutely no reason at all.

‘Do you want to go to hospital?’ they asked as I stood there watching him go through his act.

He nods. No surprise there then.

Off he goes, a couple of hundred quid of our money; not a penny of which he’s earned himself and he will take up space reserved for more deserving cases today. Then he’ll leave of his own accord and play this game again when he feels like it. We are a stupid, self-destructing nation of fools with no backbone and no ability to refuse anything, lest we get sued!

The next one I got, a 50 year-old ‘unconscious’ in a doorway was, of course, just sleeping it off as well. This time, I cancelled the ambulance and moved him on to the nearest park...or anywhere less public than a street full of concerned tourists who don’t know what a sleeping alcoholic looks like.


A 40 year-old man ‘unconscious’ on a bus wasn’t...as if you didn’t know by now. He was taken by police because he kicked off as soon as he was awakened from his slumber – these guys are getting more and more dangerous. I had been sent on a call for a female having an allergic reaction who thought she might die (OTT, I think since most people who are dying don’t have the luxury of time to record it on the ‘phone with us) – it was still an emergency call but then, half way to the address, I was cancelled for the drunk on a bus call because, wait for it...it was a higher priority! This is absolutely crazy. Statistically, an ‘unconscious’ person on a bus will be nothing more than a sleeping drunk as opposed to the higher risk that a minor reaction could be a full blown anaphylactic event.
Somebody somewhere is going to die because of this computerized nonsense...and you know what? It’s not our fault and it’s not the Government’s fault – it’s EVERYONE’s fault. If it wasn’t for the fact that we simply cannot accept that mistakes are made and that life’s tough sometimes, we’d have a human-driven system that would make things a lot easier and probably cheaper for us. No more time-wasters – no more pandering to alcoholics and drug addicts. No more picking up the pieces for the bus companies, who are all privately owned and profit-making companies. Why the hell are we running around waking drunks up for them? Hire your own security people, I say. We don’t get calls from Burger King to wake up drunks – they have their own people chuck them out onto the street.

And while I’m ranting, what’s the deal with Murphy’s digging up just about every road in Central London on the same day? Traffic was a nightmare and getting to calls on time was almost impossible. Thanks guys – smart move.

PHEW!


A theatre in Soho was the setting for my next call. A member of staff, a 25 year-old woman with a possible cardiac history, had fainted. She told me she was waiting for the results of a recent ECG and that she was being booked in for a tilt test. I checked her blood pressure in the upright and supine positions and found that it dropped when she was supine (lying flat), increasing only when she sat up.

We waited for the ambulance outside in the fresh air because the inside of the theatre, two floors down, was very hot and noisy – not very conducive to a full recovery.


As I sat on Trafalgar Square absorbing the atmosphere, I was approached by a police officer and a couple with a baby. The officer told me that the woman, who’d been holding her child with one of those front-strapped harnesses, had fallen and the child had hit his head on the ground. The baby was only 12 weeks old and the mother was beside herself; panicking at the thought of what damage might have been done as her weight fell onto the child.

I felt the bump on the baby’s head – it was big but not huge and there was no bleeding. The child was alert and easily agitated, so all looked good and I told the parents that I wasn’t worried but that an ambulance would be a good idea, considering the baby’s age. I asked Control to send one and we waited for five or six minutes while I got all the details I needed.

When the ambulance arrived, the crew took the two worried adults and one not-so-bothered baby to hospital. Before the crew left, they were approached by another little family who were re-directed to me. It was another running call. A French family’s 6 year-old boy had fallen from a statue he’d climbed and couldn’t move his arm properly. It hung limply as he held it with his ‘good’ arm. He had fallen from about six feet onto the grass but it was enough for me to suspect that he might have broken his wrist.

He wasn’t in a lot of pain but his posture and the protective way he held it meant he should go to hospital for an x-ray. I asked the family to wait while I called for an ambulance but I was told that there were none around and, on a call like this I knew I was unlikely to get an immediate response. I told the family that there would be a bit of a delay.

I waited for fifteen minutes but no ambulance came and Control confirmed that nothing was yet available. We were busy.

As I explained the problem to the family and told them it may be best to get a taxi to A&E, I received a call from a MRU colleague. He told me that a patient – an 11 year-old girl who’d fainted earlier – had been waiting for an hour to be taken to hospital by ambulance. She was now on an IV drip because her BP had dropped so much. I was asked if I could go and transport her and her mother to hospital. Of course, she became the priority and I asked the French parents to take their son to hospital by cab, apologising as I left.

I got to Oxford Street, where the young girl was waiting, IV in situ. I drove her and her mum up to hospital in five minutes. The call had been categorised as a Green2. I simply don’t get this...I was being sent on Red calls for ‘unconscious’ people on buses and in doorways and yet an eleven year-old child faints and has low blood pressure is given a much lower priority. It’s all gone mad.


The one job of the day I could be proud of was this one; a 55 year-old man was choking at a hostel. At first, as with all ‘choking’ calls, I was sceptical about the accuracy of it...we get many calls like this and you rarely turn up to find someone actually choking.

As I made my way there, the call category changed from red to amber and back to red again, so something wasn’t quite right. I pulled up on scene and a couple of female members of staff were waiting outside for me – they waved and fluttered like panicking chickens.

I went into a dining room and a man was sitting at a table, a plate of food in front of him, making the most awful sounds. He wasn’t breathing and his chest was growling as it desperately attempted to move air around.

‘Have you done anything for him?’ I asked the gathered members of staff.

‘Yes, we tried hitting his back and thrusting his abdomen but it didn’t help much’.

The man was on his last legs, so I thumped his back...nothing. I got behind him as he sat in his chair and I carried out the Heimlich’s manoeuvre. A chunk of food flew from his mouth after my third attempt and he began to breathe but it was still very noisy. He had a glassy-eyed look about him and he wouldn’t respond to me at all, so I dragged him from his chair and prepared to carry out emergency procedures to keep him stable until the crew arrived to help me out but given my experience with the day so far, I thought it would be prudent to call Control and make sure an ambulance was coming for this one.

I tried to inspect his airway but his mouth was clenched shut and I couldn’t open it. I was sure there was more stuff to come out but I also suspected something else might have happened to him, prior to his choking trauma. He may have had a stroke.

As I supplied him with oxygen and listened to his chest for the free movement of air, the crew arrived and I explained what was going on. Just as we prepared to get him to the ambulance, he gave a long loud cough and a huge chunk of food flew onto his chest (see pic). This is the bit I’d pushed up from his trachea. It had been sitting in his pharynx (back of his throat) until now and that was why his breathing still sounded noisy. He couldn’t have inhaled it again because it was far too big.

When it came out, I lifted it up and there was a gasp of shock from the people around me. Ironically, one of his mates started tucking into his unfinished dinner as he lay on the floor, potentially dying of asphyxia. I found that sight remarkable but typical in a place like this. I looked down at him again...

‘Hello’, I said, ‘You’ve been choking but you’re alright now’.

He continued to improve and was talking a little when the crew took him away.

We don’t get many chances to treat choking, most are resolved (or dead) by the time we get to them. This was a rare opportunity for me to save a life using a technique that I teach an awful lot in first aid classes. I’ve only had to do this a couple of times in my career and it’s a very satisfying achievement. It made me feel good when I left the place.


I was just about back at station when I was asked to go and wake up a notorious drunken man who’d become ‘unconscious’ in the park at the London Eye. Two cops were on scene when I got there and they had been having no luck getting him to respond. We of the ambulance service are experts at waking the dead and it took me ten seconds to get him to sit bolt upright and stop being an idiot. I knew him and the cops decided to take him away themselves. I cancelled the ambulance and made my way home after a long, hot and traffic-filled day in which one life was saved and all the other calls seemed like routine duty stuff.

* At the time of posting, another fatal stabbing has taken place in London, on my ‘patch’. I wasn’t on duty but my colleagues would have struggled and done everything they could for this man. It’s a damned shame and it’s a sign of bad things to come. We already wear stab vests, what’s next - vests for ordinary people on the street? It’s high time we stopped pussy-footing around with these little killers. A mandatory prison sentence of ten years for anyone caught carrying a knife without good reason, on a three-strike basis. Go on Mr Brown, let’s see if you have the nerve...or are you, like the others, too scared to challenge the human rights of those who deprive innocents of theirs without compunction?


Be safe.