Tuesday, 30 September 2008

Viagra man

Day shift: Six calls; one assisted-only; one taken in the car and the rest by ambulance.

Stats: 1 Abdo pain; 1 Asleep; 1 Ankle sprain; 1 cardiac problems; 1 ?food poisoning; 1 non-cardiac chest pain.

An alcoholic staggered towards my car when I arrived on scene. He’d called us from a phone box and waited for my arrival at 7am. He had right-side upper abdominal pain and a history of liver problems – surprise, surprise. The 38 year-old seemed in genuine pain but the fact that he’d been drinking all night kind of put the brakes on my usual outpouring of sympathy, although he still got the same treatment everyone gets – pain relief and an ambulance to hospital.


An unconscious man on a bus got a rude awakening from the crew as they stepped on board just ahead of me. Before I’d reached the bottom of the stairs leading to the top deck, he was making his sleepy-headed way down with my colleagues behind him. Prior to this thirty-second action the bus driver and his mates at the terminus had stood and watched in what I can only describe as awe, as if this had all been an LAS magic trick. Once removed we felt it was our duty to remind the bus staff that it’s quite easy and not very dangerous to shout at someone and wake them up – ‘Kindly exit the vehicle because it has now terminated’ or ‘Oi! Get off the bus' will do.



A sunny weekend meant a lot of visitors to the centre and my next call was to an Italian man who’d stumbled down a few steps but had been clumsy enough to sprain his ankle in doing so. Only one member of his family spoke English, so she became my interpreter, although she wasn’t always accurate. When I suggested taking the patient to hospital in the car, she looked dumbfounded and asked me why I thought her father should be driving at all with a dodgy ankle, never mind in an emergency vehicle he’d never been trained to use!

I managed to untangle the conversation and took the hopping man and his daughter in the car. The rest of the family had to walk across the bridge to get to the hospital. I really need a special ‘patient’s friends and relatives roof rack’.


On a number of occasions I have bored you with the fact that I receive calls to the National Gallery or the vicinity of Trafalgar Square when I am sitting on it on stand-by. Once again, I proved to be in the right place…blah, blah, when I got a call for a 60 year-old man ‘not alert’ in the Gallery’s restaurant. It took me all of ten seconds to respond…I did a U-turn and parked up basically.

The man was with his wife and he’d passed out before proceeding to vomit a number of times. Other diners carried on eating and drinking, as they do but they donned their ‘not really looking’ faces and you only get that in places where food is being consumed at the same time as vomit is being expelled.

The crew arrived soon after I’d started my obs and the man never really showed any signs of improvement; he was very pale, very unwell looking and still unstable in terms of his level of consciousness. I could see a possible cardiac connection here and when his ECG was done in the ambulance (he had to exit on the bed because he needed to lie down) it showed a possible heart block, which had the effect of slowing his heart rate down and causing his blood pressure to drop. There was no doubt about him going to hospital of course.


Panicking neighbours flagged me down as I arrived at the address of the next patient. She had a history of CVA, so because she’d collapsed in the toilet and was suddenly weak and doubly incontinent, the assumption was that she’d had another. When I got to her she was lying on the toiler floor with a pool of fresh vomit around her head. She was well aware of what was going on and there was no weakness or lack of function as far as her limbs were concerned. In fact, her story, related to myself and the crew when they arrived, indicated a possible food link and food poisoning seemed likely, although a CVA can never be ruled out pre-hospital.


My shift ended with a 75 year-old man for whom an ambulance had been called because he was complaining of chest pain. I found him sitting in the doorway of a pub, surrounded by young women, all of whom seemed concerned about him. He was smiling, chatting and giving a tourist directions when I approached him. I had to wait until he’d finished before I could introduce myself, although the uniform and recent blue lights and sirens should have been the heaviest of hints. He was properly distracted, however. Well, he was until he was aware of me, then he clutched his chest and an agony crossed his face for my benefit.

‘What’s wrong?’ I asked.

‘It’s me chest. I fell onto a table three days ago and now it hurts’ he informed me.

‘Three days ago?’

‘Well, I thought it would get better if I just popped some paracetamol’.

At least I knew it wasn’t a cardiac complaint. He didn’t have any heart problems and he discussed his sex life at length to the crew when they joined me, proving that he still had life in him yet.

‘Yeah, she lets me have Viagra three times a week. I’ve got to perform twice tonight’, he tells us as we wince and smile at the same time.

Be safe.

Monday, 29 September 2008

Man hits bus - bus hits back; bus wins

Day shift: Six calls; all by ambulance.

Stats: 1 RTC with minor injury; 1 Hyperglycaemic; 1 Dizzy person; 2 Chest pains 1 RTC with potentially serious injuries.

I had to take myself off to Moorfield Eye Hospital before I started my shift. This chronic conjunctivitis, stye or whatever I have been suffering for the past five months had finally got the better of me and a colleague suggested I do something about it. I’m lazy like that – I don’t go to see my doctor unless I think something will kill me or it gets so annoying that I’m left with no choice. I’m not the best ad for medical compliance.

So, I went and I got it diagnosed, after worrying that it may be cancer or something ugly and permanent. I have Blepharitis. It’s not dirty and it’s not infectious. I didn’t get it from a patient (which was one of my theories) and I have been walking around with the world’s reddest (and at times most swollen) eyelids for ages…for nothing. All I need to do is bathe them twice a day every day for as long as it takes. Silly me.



I was cancelled for the 6 year-old who’d fallen from a third floor window and given a bus vs. pedestrian call instead. I arrived to find her sitting on the bus, nursing a bruised leg, which she earned by crossing the vehicle’s path while it was still moving. Tsk!


A 33 year-old diabetic lady allowed her blood sugar to reach a level where my monitor (and hers) read ‘HI’, indicating that it was too high to be given a number, so she was given fluids and taken away from work and off to hospital. She’d been vomiting and feeling very unwell for days. That, I suggested, was the best hint she’d get.


My next job was a running call. I was flagged down by someone as I drove back from re-feuling my car. I thought he wanted a taxi and was just about to explain that I was an ambulance when he asked if I had been called to his office. I told him that I hadn’t but I checked with Control and they confirmed that an ambulance was on its way to this address. I stopped to help out and was directed to a very large builder who was sitting outside a construction site, looking quite pale. He’d suddenly become very dizzy and unsteady on his feet. He had to hold on to me when I moved him from the wall he was perched on to a nearby chair.

The ambulance turned up within a minute of my obs and I handed him over. I don’t think he was in danger but his dizzy spell would have to be investigated. Cardiac problems manifest in many ways.


My first of two chest pain calls led me to a van parked in the street, inside which a man sat, pale and sweaty, clutching his chest. His first words were ‘I’m HiV positive’ and I thanked him for telling me. I have no fear of this but it’s nice to be informed; it shows respect for another person’s safety.

The man had a history of MI and this looked real enough to be another, so he was taken to hospital without delay as soon as the ambulance arrived.


The second chest pain I was called to wasn’t my patient. An ambulance had been despatched but I was asked to take a piece of equipment to the crew because theirs had failed. I ended up following an ambulance, which I assumed was the one I was tasked to accompany, to the wrong call, half a mile away. Once I’d realised my mistake, I got back on track and found the crew and their patient at a private medical centre in the city.

It sounded more like a PE than cardiac-related and once I’d handed over the equipment required, I left them to it. I am the humble servant of those who need me. I would draw the line at delivering tea though.


On the way back, I came across a RTC in which a bus had hit a pedestrian. Three solos were on scene and I stopped to assist (I am basically nosey and like to keep busy). The man was on the ground and complained of shoulder and hip pain. The large crack (photo) on the windscreen of the bus indicated mechanisms for potentially serious injuries, especially if his head had made contact, so he was collared, boarded and taken away to hospital. I assisted by being yet another emergency vehicle obstructing the free-flow of traffic in the area. Still, it’s nice to know that I’m useful.

Be safe.

Sunday, 28 September 2008

Fresh meat in Fresher's Week

Night shift: Eleven calls; three assisted-only, all the others by ambulance.

Stats: 4 eTOH; 1 RTC with facial injury; 1 Unwell adult; 1 drug overdose; 1 DIB; 1 Mental health problems; 1 Faint; 1 Assault with minor injuries.

Fresher’s week and all hell breaks loose in the bars and clubs as young, soon-to-be doctors and scientists of all kinds learn how to become as drunk as possible in as little time as possible. To them it’s a rite of passage but to us it’s a long night and damaging for the all too important performance figures.


My first drunk was a 30 year-old alcoholic at a hostel. Known to be aggressive, he didn’t let anybody down and spent the time we had on scene with him abusing the crew, so he was left where he was, sitting in his own urine as the staff tried to figure out what to do next.


Up the road a 45 year-old man was hit in the face by the mirror of a bus. He had minor facial injuries and, after the crew had tidied him up, he declined to go to hospital. I couldn’t blame him, on a night like this you don’t want to be sitting in A&E waiting for hours to be seen. Not when it seemed like every eighteen to twenty year-old from the local Universities were being brought in out of their skulls.


A 30 year-old night shift worker lay on the floor of her sprawling workplace, feigning hypoglycaemia for some reason. Her comrades were so convinced of her illness that I arrived to find one of them shoving a spoonful of tomato sauce in her mouth. Her BM was normal, as were all of her vital signs. She didn’t speak at first but then she began to communicate once she realised the crew was going to take her to hospital. I don’t believe there was anything wrong with this lady – I think she just wanted to get away from work for the night. This happens commonly and I wish it was that easy for us sometimes.


The calls for ‘unconscious’ persons began soon after this and I attended a 25 year-old male who was slumped in the street after taking alcohol and drugs on board. The police were on scene and the crew arrived soon after me, so all I had to do, as usual in these circumstances, was carry out my obs.


Not only do the young learned people of this part of London get as drunk as possible but a good proportion of them, in denial by proxy, are said to have had their drinks ‘spiked’. You can usually tell the difference between a truly drugged drinker and a truly drunk one. The 26 year-old female I went to the aid of was truly drunk. Her friend, the proxy witness to the fact that she MUST have been drugged by some filthy man because she NEVER behaves likes this after a drink, couldn’t even tell us where she was exactly and it took an area search and a few more calls back to find her. By that time I’d grown bored of it and the crew took care of her (she walked onto the vehicle).


I had just got back to station when I was called out again with the crew who’d been there. A 22 year-old man was ‘unconscious’ in the street, a few hundred yards down the road from the station itself. He was lying on the pavement, surrounded by helpful people. He had vomited heavily and was clearly too drunk to go anywhere. In fact, how he got as far as he did was a miracle.

The helpers weren’t all impressed and one of them said ‘are you sure he needs to go to hospital?’ He followed this query with ‘is it worth taking him?’ Well, no I would have said but the man was useless to himself and everyone around him, so he had to go somewhere safe. Ironically, he’d chosen to fall down on the doorstep of a pub. Maybe he was trying to say something.


I wasn’t required for the next call; a 2 month-old who’d ‘gone stiff’ and now had DIB. The crew was on scene and this would probably turn out to be no more than a high temperature episode.


Back into the West End and I watched as a 22 year-old girl, who’d been drinking of course, howled and moaned her way into the ambulance with the struggling crew as her boyfriend and other men (who would consider themselves ‘decent types’ no doubt) harassed them. I put myself between them to diffuse the situation a little and let the crew get on with their job. The girl was convinced she was having a stroke. We were more convinced of the power of alcohol. The crew had probably just dealt with half a dozen of these calls earlier and had more to come as the night wore on.


I was flagged down as I attempted to get back to the station for a coffee. One of those pedicab drivers (cyclists) told me that someone was lying unconscious on the pavement, so I went to have a look and called it in as a running call. The man on the ground was known to me – he’s a Soho local and is always aggressive, even though he wears a selection of gold crucifixes and other religious bits and pieces. His hands are adorned with obscene rings and he has a large gold (he likes gold) watch on his wrist. None of the jewellery looks worth anything but that won’t stop someone from robbing him if he goes to sleep in public places like that, so I shook him awake and got the full-faced wrath of God for my trouble.

He leaped to his feet, threw down his jacket and postured for a fight with me. I calmed him down and took a step back until he simmered. Then he blessed me and told me how much God loved me. I had to accept that the miracle of not getting a punch in the face from him for trying to help must have been some indication of that love. He shuffled off and I went back to the car and stood down the Cavalry.


Back to someone’s workplace for a 30 year-old female with the most amazing brown eyes I have ever seen (and I don’t mean that in a sleazy way, of course – they were just very striking). She’d fainted on arrival at work and she had a history of this but nothing had ever been diagnosed. She declined to go to hospital because she felt better by the time I got to her but I managed to persuade her to go with the crew to the ambulance and get checked out. She was happy to do this but still insisted that she wasn’t going to hospital. At last, a night-shift worker who wasn’t using us as a means to get time off.


I’ve been to many calls where door security people at clubs have been accused, rightly or wrongly, of assault. I think in most cases the person making the allegation has done something wrong and during the ejection process has resisted, so that reasonable force became a little less reasonable. I won’t make a judgment on it because I never see these alleged assaults and door security have enough work as it is just dealing with some of the idiots they have to control after a boozy night out.

My last patient of the night, a 24 year-old man, claimed he was punched around the face and ‘strangled’ to the point where he believed he would die after an altercation with one of the doormen. To be fair, his story, related to me as he sat in my car and we waited for the ambulance, was full of holes. It sounded to me like he’d started an argument with one of the men when he was asked to leave for being too drunk and annoying. In the real world, if you argue when being asked to leave a club, you are more than likely going to be dragged out forcefully. During that process, if you continue to struggle or fight with them, more force will be used. That’s just the way it is, right or wrong, as I said.

I jump to nobody’s defence here you understand but if a drunken person tries to be aggressive with me, I will not allow it (I’d stop short at strangling, punching or kicking, however).

Be safe.

Saturday, 27 September 2008

Ending it all

Night shift: Five calls; one false alarm; one dead on scene; three by ambulance.

Stats: 1 MI; 1 Suicide; 2 Chest pains.

An 82 year-old man with chest pain and DIB, a history of type II diabetes and heart failure probably had a UTI – he hadn’t urinated for three days and his condition was complicated by the fact that he was now having an MI. His ECG was textbook and the training crew that arrived to take him away had their first lesson in treating the obvious when they were told about it by their Supervisor.


I wasn’t required to do anything on the next call and the crew on scene simply completed the necessary ‘life extinct’ paperwork as I left. The 30 year-old had apparently committed suicide in the hostel where he stayed. He’d blocked the door to his room with a barrier of furniture and killed himself in the toilet, where his body was found by staff, lying on the floor at the side of the toilet bowl. Water surrounded him and he had had a head injury, which was probably sustained when he fell. The likely cause was an overdose but the police and Coroner would be left to work all that out – there was nothing we could do to help him and, with all the effort he’d put into his demise, it was unlikely he could be saved even if he’d been found earlier.

The water on the floor and the towels used to seal the gap between the bottom of the toilet door and the floor had served some purpose but I don’t know what it was – he certainly hadn’t drowned.


A false alarm (or not) next for a ‘person in the river’. Someone had been fished out dead earlier in the evening and now another man or woman had jumped in to drown. Despite a search by the river police and rescue boats, no-one was found. I stood on the bridge, looking over into the water alongside a few of my colleagues but it all came to nothing as we were told to stand down after a while.


Chest pain isn’t always cardiac-related and right-sided pain makes that possibility less likely, so my 58 year-old patient, whose BM and BP were both on the high side, may have been suffering from a pulmonary embolism. His ECG showed bradycardia and he was uncomfortable. He was given oxygen, monitored and taken to hospital.


On the other hand, chest pain in the absence of any clinical signs whatsoever can mean something and nothing. My last patient was 25 years-old and she insisted that she had severe chest pains, even though her vital signs were all good and her ECG was normal. I thought she may be making a drama out of it and it got her the night off work but I don’t want to be too quick to judge such things because every now and then you get calls like this – seemingly for nothing but they turn out to be significant. I still doubted her though, I have to say.
Be safe.

Friday, 26 September 2008

Not all crashes are bad

Day shift: Five calls; two assisted-only, three by ambulance.

Stats: 1 MI; 1 eTOH fit; 1 Dizzy person; 1 eTOH; 1 ?CVA

An unusual case to start the day. A 57 year-old man crashed his van into the barriers at the side of a busy road after having what everyone thought was an epileptic fit. The crew was on scene and I arrived as they took him into the ambulance. He certainly looked as if he’d had some kind of fit and there was evidence of him having lost bladder control in the vehicle but his demeanour shouted a lot more about him and his ECG appeared to show that he was having an MI but our ECG’s can be unreliable at times and when he got to hospital they discovered that he was in unstable VT.

It turns out he’d gone into VF whilst driving and lost consciousness as he began to arrest – this caused him to roll into the barrier as his vehicle crossed the road under no control whatsoever. The collision wasn’t enough to hurt him badly but it did create a significant thump to his chest and this acted like a defibrillator, bringing him out of VF and into VT. His life was probably saved by it and he most likely had a seizure as a result of oxygen deprivation.

He lay on the bed in Resus telling everyone that he felt fine, while his ECG did strange things and the staff put defib pads on him. I probably won’t see that combination of events for the rest of my career.


A 67 year-old alcoholic had a fit at a train station (in fact, according to witnesses he had three). The crew was on scene with me and another turned up for good measure but he was stable and didn’t fit again as far as I’m aware.


The new drugs for Parkinson’s work well to control the symptoms and my next patient, afflicted with this condition, suffered a dizzy spell after walking around all morning with his wife. The man looked perfectly fine as he sat on a bus and if he hadn’t told me he had Parkinson’s I wouldn’t have known. After a long chat, in which I learned that he used to be an architect and that he dabbled in digital photography and knew more about computers than his grand-children, the crew arrived to take him on board for further checks before letting him and his wife continue their onward journey home.


Another alcoholic who was said to be fitting wasn’t in fact. He just lay on the pavement, worrying passers-by. He still had the pyjama bottoms on from his last trip to hospital and he wasn’t interested in another visit, so I helped him up and he staggered away to a better place for sleeping.


An off-duty nurse helped me with my last patient, a 40 year-old man who was suffering a ?CVA at a train station. Screens had been erected around him, which is always useful and something we can’t carry around because of the lack of space in our vehicles but they served me well and the privacy and dignity of the patient was preserved as people rushed around catching and leaving trains.

I had enough time to put a line in, just in case, before the ambulance arrived to take the confused and agitated man away.

Be safe.

Sunday, 21 September 2008

Agonal

Day shift: Three calls; one assisted-only, two by ambulance.

Stats: 1 cardiac arrest; 1 asleep; 1 hypoglycaemic fit.

My morning started out with a call for a 50 year-old man with abdo pain but it turned out to be much, much worse.

The crew was pulling up when I arrived and we all went into the hotel together. There was a panic-stricken look about the staff when we got to the relevant floor and, although we were still going to an abdo pain as far we were concerned, there was something about the look on those faces that said we were wrong. I mentioned to my colleague that the last time I’d had this feeling about a call we found our patient in cardiac arrest. I hadn’t got much further than the room door and the sight of a pair of very white feet on a bed when I heard my name being shouted.

The man was lying on his back on the bed and his wife and a member of hotel security were standing around it. My colleague was preparing the defib and his crew mate joined him immediately. I’d brought my bag up and we all knew what the drill was going to be from that moment on.

The patient was pulled to the floor, shocks were given and we worked on him for a seemingly endless time before another ambulance crew arrived to help us move him. All the time, his wife sat nearby.

‘Are you sure you want to be here?’ I asked her.

‘Yes but if I don’t like anything I’ll look away’, she said.

CPR is a noisy, messy business and the man’s airway needed clearing of vomit a number of times – a few times it had to be done manually and with his body flung to the side because the machine just couldn’t handle it. The hotel room carpet was ruined.

Throughout the procedure the patient was drawing breath. I’d never seen someone in VF continue to breathe like that; it was very strange. I'd seen plenty of agonal breathing but this guy was going and going and at one point his minute-rate was 8 breaths per minute. Intubating him was impossible because he practically coughed the tube out when I attempted it. He’d need to be sedated at hospital, although I would have thought cardiac arrest was a deep enough sleep.

We got him to hospital rapidly but not before almost a dozen shocks were delivered. He came out of VF and into PEA and asystole over and over again – it honestly didn’t look favourable but we kept going all the way to the Resus bed, where the medical team took over. I watched them struggle to keep control of his rhythm too but eventually, after a few more shocks and drugs, he stabilised and, as far as I know, he’s still recovering in ITU.

This particular call taught me a lot and I’ll know how to proceed next time I come across a breathing ‘suspended’ patient. It was also the second cardiac arrest where shocks have been delivered and where something bizarre happened. On another call, the shock resulted in the patient crying out, even though he was in cardiac arrest and later died. It made me stop in my tracks, I can tell you.


It took me ten seconds to wake the ‘unconscious’ man in the doorway up and move him on after I’d been called to this emergency. The office staff didn’t want to touch him, so they called an ambulance. They could have shouted at him – that usually works and it’s free.


Apart from the first call, which used up a lot of hours and energy, there was nothing else happening today. My last call was to a 33 year-old man who’d had a hypoglycaemic fit but the crew was on scene and the man was recovering apparently, so I wasn’t required. One cardiac arrest in a day is quite enough anyway.

Be safe.

Saturday, 20 September 2008

Can opener for cars

Day shift: Numerous calls; four worth mentioning.

Stats: 1 RTC with neck injury; 1 fitting; 1 fracture; 1 petrol burn.

A shift on the ambulance today and therefore all of my patients went to hospital in the back. As usual with my ambulance stints, I prefer not to mention all of the jobs, so here are four worthy calls.


A 40 year-old woman, who turned out to be a lawyer, insisted that she had neck pain after a RTC in which her vehicle was side-swiped at about three miles-an-hour (if that) by a large truck. The poor truck driver sat in his cab, worrying about how much damage he’d caused to the car driver, as she winced and moaned in pain every time she moved. Allegedly she’d been on her phone shortly after the accident and didn’t complain about anything until she’d had a conversation with someone on the other end of the line (why do we still say that when clearly there are no 'lines' involved with mobile phones?).

Every opportunity was given for her to tell us she could get out of the vehicle but she was adamant and, as a result, the LFB were called and within the space of twenty minutes she lost the roof of her brand new £40k Mercedes. It was a birthday present. The pavements quickly filled up with people - mostly car-loving men - who watched in horror as this beautiful machine was peeled open like an orange. The fact that there was a potentially injured person inside failed to register with them I think.

Ironically, the damage caused by the truck would probably have cost no more than a few thousand to repair. Still, one can’t refuse a patient’s wishes.


Then there’s the repeat offender in North London who has fits after smoking dope and then gets all annoyed and aggressive when we try to help him. We were called to him twice today and on the first job he wasn’t answering his door at the hostel where he lives. We shouted his name, banged with our fists and did everything possible to get his attention.

His Careline alarm had gone off (he wears a sensor which detects if he’s having a fit) and we were called to assist. He may have been dying inside his room but we just couldn’t get to him.

I tried a window outside and managed to slide it open (one of those sash type things). I could see him lying face down on the bed and I shouted in at him until his feet moved. I couldn’t lean too far in because I would have fallen into the basement below and that would have made my heroic climbing act look dumb. The FRU paramedic, who’d arrived just before us, had an idea though. She brought an old broom over from the garden and used the handle to get the man’s attention by prodding him through the open window. It was funny and practical at the same time.

He got up and opened the door for us and we spent the next thirty minutes arguing with him about going to hospital. He’d clearly had a fit and was still post ictal but he frustrated us with his attitude, which had nothing to do with his epilepsy.

The smell of freshly smoked cannabis permeated the room and it was still strong enough to give us all a buzz if we breathed too deeply, so we worked quickly to get him to agree to go to hospital.

After a good while, he relented and came with us but he didn’t stay long and we found ourselves back at his place later on for some more fun and games.


Children tolerate fractures very well, generally speaking; their bones heal quickly and they can suffer a serious break with very little or no pain. This was the case when I attended a 5 year-old Polish girl on a bus, who’d fallen whilst going down the stairs. She’d landed hard on her arm and broken it mid-shaft at the Humerus (the not-so-funny bone). She sat on the bus waiting patiently for us to come and showed no discomfort or distress, even though she told her mum that it hurt.

I carried her out and into the ambulance, where she took some entonox during the journey to hospital. She didn’t whimper once.

I learned later on that she’d need an operation to bring the bone back into alignment and while I spoke to her non-English speaking mum through her translating sister, I discovered an anomaly with the Polish language. Apparently, to say ‘ta-ta’, you say ‘papa’ and to say ‘papa’ you say ‘tata’. What’s that all about?


If you have a problem with your car and you are feeding petrol into it over the engine it’s probably best not to have someone turning the ignition at the same time. My next patient got burned when his wife clicked the key while he was pouring petrol directly into the engine because his fuel pump was bust. Crazy, really. The spilled stuff ignited and he was flash-burned for his trouble.

‘Yeah, turn it over now….’

‘Oh, wait no, DON’T!’

I think that’s how he said it went before he saw the light. It took 10mg of morphine to stop him screaming.


And back at the hostel with our epileptic drug-smoking friend, we argued again. Another FRU had been called and we arrived to find the patient slumped on the floor. His friends said he had another fit after a smoking session with them. He’d only just been discharged from hospital. This time he was rude, aggressive and very loud about his protestations. If I’d been able to accept that he had capacity to refuse I would have left him at home quite frankly.

In the end the police had to forcibly remove him to the ambulance, for his own good. That shook him up a bit and I felt guilty about it to be honest. It wasn’t my call and I wouldn’t have done that myself but sometimes the good of the patient has to be decided for them and if they are going to be violent (in the absence of capacity) then the police can be very helpful.

I know that he has since played the same game a number of times with other crews. One day he’ll be in real trouble with his condition and nobody will believe him.

Be safe.

Thursday, 18 September 2008

The Dancing Panda

Amy becomes a drip stand and shows her disapproval for time-wasting drunks.

Day shift: Seven calls; one false alarm, two moved on by police and four by ambulance.

Stats: 1 Near-faint; 1 Abdo pain; 1 drug overdose; 3 EtOH.

It was a day of time-wasters and by the end of it I was very annoyed because their antics led to my going home late with an early start the next day. It’s so difficult to smile when you know there’s an hour-long drive and very little sleep ahead of you.
I had an observer with me today. Amy works for us but she's not frontline, although she does come out to watch us getting our hands dirty from time to time. She is a respected face and I get along well with her - she is a lovely person. She enjoys singing and dancing and confessed that she'd like to dress up as a Panda and dance around in costume. This prompted another colleague to reveal that he would like to dress up as a gaurdsman and sit outside Horsegaurd's Parade with a bottle of booze, just to see what they said. The bizarre discussion had me imagining the two of them dressing up and walking hand-in-hand down Oxford Street...just to get a reaction. This conversation, I must add, took place over a coffee when we were on a break. Only coffee was consumed, however.

So, it started with a 50 year-old man who, slumped against a wall in the street, decided he was blind. He was certainly blind drunk and had been pretending to have a fit. I was parked in the middle of the road so that traffic could flow but every time I crossed it I was dodging buses in the bus lane. The ambulance crew had the same obstacle course to run when they picked the man up and took him to the vehicle, where his temperature was taken and couldn’t be read because there was so much ear-wax on the thermometer probe – there’s never an excuse for dirty ears.

He was a thoroughly unpleasant man and frequently swore and spat at us. I believed he was blind because he acted the part well, although I doubted he would be allowed to wander about without a white stick…or a dog. Oh and he claimed he’d been robbed by other street people. Imagine that, his stick and dog stolen by unfeeling homeless thieves. This guy was new to me and, as you know, for the benefit of any doubt I will always allow you to make a fool of me once. So, off he went to hospital.


A 72 year-old man who’d near-fainted at an underground station but was recovering was taken to hospital anyway because he had a cardiac history with a previous heart attack. He also had a low pulse rate and that always arouses suspicion.


Then there’s the story of the stupid 18 year-old girl who created way too much trouble when her friend called an ambulance thinking she’d stopped breathing. The Red1 call had me racing to the hotel and up to the tenth floor, accompanied by panicking staff. She was lying on the bedroom floor doing the ‘I am dead’ act. She had managed to convince the people around her, so her ambition to become the world’s best actress was almost within her grasp but it wasn’t Oscar-winning and that’s what you need to persuade me and my colleagues.

After convincing her that I knew she was faking, I managed to get her to communicate using her eyes because she simply could not…or would not talk to me. So, it was the old one blink for YES and two blinks for NO routine.

‘Have you been drinking?’

One blink

I then turned to her ‘best’ friend. ‘Does she take drugs?’

‘No, never. Absolutely not’.

Back to my winking patient. ‘Have you smoked any drugs today?’

One blink.

I worked on the basis of ‘drugs you can smoke’ and went through the list with her until she blinked once at ‘dope’. Ah-ha! I also think the word was highly appropriate, given her condition and the worry she’d caused.

It took more than ten minutes but I eventually got the whole story from her and her friend. She’d snuck out of the room for a fly smoke, unbeknown to her friend and had reappeared at the door, just to collapse dramatically as soon as her mate opened it. She’s not an experienced druggy and the stuff she inhaled had been given to her by a complete stranger the night before – dangerously na├»ve.

The crew were not impressed and she was marched downstairs, still not talking, completely spaced out.


I met my blind man again after that. He was curled up asleep in a call box and a MOP had dialled 999 – from an unoccupied box, ironically, when panic set in and he thought the ragged, smelly human being might be dead. Worse still, he might be giving the area a bad name.

I woke him up at arms distance and he launched a verbal attack on me. His eyes, now miraculously able to see, were oozing yellow gel. I can only assume the hospital gave him a prescription for them and he’d squirted it on as if one drop meant the whole tube. The alternative didn’t even bear thinking about.

Eventually a kindly police man happened by, as they do and he offered to take care of the problem for me. All the guy wanted to do was sleep but he was choosing the worst places to be in broad daylight – he really needed to be out of eye and nose range of everyone.


Abdominal pain is taken seriously by us but it an abused symptom, often over-dramatically described and used as a tool for getting into hospital as commonly as chest pain. My 42 year-old Romanian, non-English-speaking patient rolled around on a sofa, half-naked (for reasons I will never understand) in a local tourist hotel, complaining of pain. She had no medical history and played more on it when her friends were around than when they weren’t – always a bit of a clue.


At the end of the day my patience was tested with two calls that were intrinsically linked. The first, to a 50 year-old man ‘unconscious’ in the street, led me to a Polish alcoholic who was feigning epilepsy. He and his mate had been found lying there by local workers but his friend left the scene when I showed up. A couple of wine bottles stood next to him and they were testament to his true state. So, he started with fake epilepsy, which was dreadfully acted out, then he tried to convince me he had a broken leg. He stood, walked and leaned on it, so I guess I was supposed to stop him or something. That didn’t work, so he told me his pregnant wife was in hospital and I should take him, even though it was not the local hospital. Obviously, the local medics had already met him.

Now, before some of you get all hot and bothered, I am NOT racist but our visiting Polish alcoholic friends have a system…they use epilepsy to get into hospital because they think every paramedic is going to fall for it or they think we are somehow duty bound to take them in simply because they shiver a bit on the ground. Most of them have never seen epilepsy and they insult those who genuinely suffer but they have chatted to each other about this and it’s how they get to the alcohol gel; that’s what they want. Wine and beer just doesn’t cut it any more.

I couldn’t convince him to leave the area, so the police were called and he instantly got better when they arrived. That’s another thing; they all know that our uniform means nothing in terms of consequences for their behaviour. The officers moved him along and he practically leaped off on his broken leg…in the opposite direction in which his poor pregnant wife was supposedly languishing in hospital. I feel ashamed that I didn’t provide this man with the medical care and comfort that he so obviously needed at my expense.

Then his mate tries to pull the same stunt further down the road. I was astonished at the gall of him. I guess he thought another ambulance would show up, since I was busy with his friend up the road. He guessed wrong – at that time of day there are few crews available, so I was sent to him and stayed on scene until I was late.
An off-duty A&E nurse and his female friends helped me (they were the ones who'd found him) as I tried to persuade him to stop the act and go away...somewhere else. He was determined, however and I had to go throught the motions because I knew that an ambulance weasn't coming any time soon. I put fluids up in the hope that it would rinse out his blood and wake him up. It certainly made him more alert and he communicated for a short while but not to my benefit and I continued to see the hour slip past, making me even later.
The dancing Panda (she won't mind really) helped me by holding his vital fluids aloft and I flet sorry for her arms, aching as they must have been for the welfare of a man who couldn't care less.
Then he decided he needed another drink and helped himself to more cheap wine from one of his bottles. That was the last straw. I unplugged him from everything and requested police. He had no clinical need of me and had been playing the game he always plays.
Two cops showed up and lifted/dragged him away to another, less public place so that he could act out the final act of his drama...the sleeping drunk with no soul.


Be safe.

Monday, 15 September 2008

There is such a thing as a free meal!

Day shift: Five calls; one assisted-only, four by ambulance.

Stats: 1 Hyperventilation; 1 ETOH fit; 1 Chest pain; 1 ETOH

On the steps of the Albert Hall, a 16 year-old girl sat with her friends. They’d been out all night drinking vodka and she was paying the price at 6.30am. She’d vomited a lot and was now panicking, hyperventilating and generally being sixteen. ‘Don’t tell my mum’, she wailed as she was led to the ambulance after sitting for five minutes in my car to warm up.


I visited an alcoholic, drug-taking 23 year-old man for the second time in my short career with LAS next. I’d treated him years earlier and when I saw the address come up, I knew it was him. Sometimes you never forget a patient.

He lives at home with his parents and he puts them through Hell, to be honest. They find him unconscious on a regular basis and, even though I haven’t seen him myself for a number of years, he’s been a regular visitor to hospital. His mother stands in the doorway and cries and his father paces the rooms, searching for an answer somewhere. There isn’t one; the guy doesn’t care and has threatened to kill himself on several occasions.

This time, he doesn’t look well. He’s had a fit and he’s pale, sweaty and very agitated. He doesn’t want to go to hospital and there’s not a lot I can do about that. Only when my colleagues arrive and spend half an hour persuading and threatening him with the police (for his own protection) does he relent and travel with them.


Ironically, when a private doctor’s surgery has a crisis, they call an ambulance just like anyone else…the NHS is important to the private sector. Unfortunately, my attempt to reach the posh doctor’s building was thwarted by the stupidity of the council, who think it’s wise to place bollards at every entry point to the square, making it traffic-free and impossible to access by the emergency services (although I’m willing to bet the fire service has a key).

The man with the chest pain, possibly having a heart attack inside the building had to wait a further three unnecessary minutes as I parked up and walked to the location. The doctor had come out by this time and was hurriedly leading me to his patient who was two floors up and lying on an examination couch.

He was pale and a little off but otherwise stable. He had developed chest pain as he climbed the stairs to the doctor’s surgery (the doc might consider relocating to a ground floor room) but he had no cardiac history. The doctor had given him GTN and an aspirin and now his pain was gone.

When the crew arrived, the patient was suitably furnished with a line, courtesy of me and off he went, via chair, to the ambulance for an ECG. The doctor followed to have a look and seemed a lot happier when the graph appeared to show nothing of interest.


One of our regulars visited the National Portrait Gallery, got bored and feigned epilepsy, prompting the concerned staff to call an ambulance. I was despatched with a CRU and both of us arrived at the same time. We both recognised our ‘patient’ and spoke to him about his behaviour. He has a learning disability and wanders around on his own all day until he feels he can’t cope. Then he usually tells someone he feels ill, or is about to have a seizure. Nothing puts the fear of death into a MOP than the phrase ‘I think I’m going to have a fit’.

Once we’d checked him out and he’d agreed he hadn’t been feeling unwell and hadn’t needed an ambulance, he was left to carry on looking at art he may, or may not have understood. ‘Can I have a drink?’ he asked. The two female staff members obliged. He sips his drink, pauses, thinks then says ‘Can the lady show me around?’ Now, that’s just plain cheeky.


My last call was a long one. I stood over the unconscious body of a drunken young man as he lay in a puddle of his own vomit, underground in a tube station. An off-duty cop helped me as I set up fluids and dealt with his low glucose level. My volunteer drip-stand waited almost an hour with me until at last a crew arrived to scrape the drinker off the floor and onto a bed. I’m sure the officer had better things to do with his free time but I was very glad of his help. He even invited me to pop into his station in the City for a free coffee and a bite to eat anytime I was in the area, which was very nice of him. Unfortunately, I might not be able to take up his offer because (1) I don’t get to work that area much at all and (2) I’ve completely forgotten where he said it was. You’d think a free breakfast would be a priority memory for me. I’m useless.

Be safe.

Thursday, 11 September 2008

Footprint

Day shift: Seven calls; two no-trace, one left in care, one not required, one refused and two by ambulance.

Stats: 2 ETOH; 1 Unwell adult; 1 EP fit.

All day long I had to avoid much of my usual stamping ground because I had been given a footprint. This means that an area has been rendered ‘no-go’ to me and only the voluntary services and/or specifically assigned Forward Incident Teams (FIT) are allowed to operate within it. Whenever a large scale event takes place in London, a footprint is designated. When I first started on the car I had no idea and used to stumble inside them on a regular basis, much to the chagrin of my bosses.


The first call of the day was a no-trace for a 28 year-old male who’d been assaulted by three others. I was told the police were on scene but they weren’t. In fact, nobody but me was on scene…and there was no scene.


The wrong house number for the next call had me circling a one-way system until someone got it right. The ambulance crew had joined me by the time the correct information was passed to us and we looked like yellow emergency buzzards. As we travelled towards the patient’s house (an unconscious 23 year-old) a drunken cyclist fell into the road, directly in our path. The ambulance swerved to avoid hitting him and I stopped feet away from him. I picked him up and he apologised for being so drunk in charge of a bicycle. It was 7am and he was on his way to work. I hope he wasn't a police officer.

When we finally arrived at the unconscious girl’s flat, her boyfriend told us that she’d been drinking and taking drugs the night before and he couldn’t wake her up. She was just sleeping it all off and was quite easy to wake. In fact, she looked annoyed to see three men in green standing at her bedside without invitation. It all became a bit uncomfortable and it was agreed that the boyfriend would keep an eye on her and let her sleep. I could imagine the argument they'd have later on.


Another explosion under a pavement next and I was sent to the West, where flames had been seen shooting out from a paving slab after it had ‘gone off’. I watched as other resources turned up and the Fire Service made the area safe by cordoning it. The pavement had been pushed up by the force and I wondered what was causing this phenomenon. It wasn’t until I heard of another call a few days later, in which workmen had been digging up the road and had severed through an electrical cable that was too thin and too shallow that things made sense.

According to the workmen (both of whom had to be treated for electrical burns), the cable was the wrong thickness and should have been buried deeper under the pavement; they hadn’t expected to hit it at that depth. There had been a number of short-circuits in the area whenever it rained and it looks like these cables (probably in many other places around town) are exploding when water reaches them. Keep an eye out when you are walking on wet London streets. And now there's another excuse to dig up the roads again.


My second no-trace – a Red1, life status questionable, fitted the description of a regular caller. A family had spotted him lying in the street with his tell-tale suitcase next to him. They sat in their car, called an ambulance and watched as he got up, dragged himself off to another spot and lay down again. I was sent from A to B by his antics but when I reached ‘B’, he’d moved again and I wasn’t playing any more.


A dramatic 82 year-old man who called his son and said ‘I’m dying’ prompted a race to his affluent home in which an ambulance, myself and a MRU turned up for a possible cardiac arrest, only to find him lying in his bed, feeling unwell. His daughter had rushed over too and he had all the attention he required. The run up three flights of stairs with all the necessary equipment left us hot, sweaty and looking a sight less healthy than he did.

‘Will I be going to hospital by private transport?’ he asked. I wish I was allowed to print my head’s response.


A ? Epileptic fit in the street was probably alcohol-induced because the 30 year-old man had no medical history of epilepsy and he’d been out on the binge all night. His body had shut down and his brain had followed suit. He won’t learn a thing from the experience, however.


Speaking of alcohol, my last call was for a 60 year-old woman who fell at home after going to the toilet. She banged her head on the skirting as she landed and lay in the hallway as her husband worried over her. I arrived to check her for injuries but she was adamant about not going to hospital. She was drunk and her husband had been coping with her alcoholism for many years by all accounts. I felt sorry for him and he didn’t raise his voice once with her, even when she stubbornly refused any help offered. The crew was treated to the same look of disdain that I had been given and so we left them to it – her with a deadly habit and him with a life of low emotional value.

Be safe.

Wednesday, 10 September 2008

Fast food shift

Day shift: Five calls; one false alarm, two assisted-only and two by ambulance.

Stats: 1 Abdo pain; 1 Asleep; 1 Fall with no injury; 1 Back pain and 1 Faint.

A 30 year-old Japanese man was sitting in a McDonald’s having breakfast when he began to experience what he perceived to be chest pain. He had abdominal pain in fact and I barely completed my obs before the ambulance crew arrived. He had no medical history of any significance and his McD breakfast meal was half eaten. I wondered if he’d wolfed it down too quickly or it had simply disagreed with him.


I sat in the car in Soho with a cup of coffee (purchased for a mere quid at the place where all the local solo’s gather) when I got a call from Control telling me to move away from the area because one of the MRU paramedics’ dosimeter had just gone off, indicating a possible chemical threat. I headed in the direction given but got stopped half way when another call from Control came through. I was travelling directly towards the incident apparently – based on the instructions I was given in the first place. I had to about-turn and go off in the opposite direction to clear the ‘danger zone’.

After an hour or so in which our HART team investigated the incident, I was told that all was clear and I found out later that the battery on my colleague’s meter was faulty, thus the continuous beeping that had alerted him. I decided to get new batteries for my own meter – I had been running around for two weeks without a functioning device. By the time the thing beeps it’s probably too late for the person hearing it anyway.


If you fall asleep on a tube train and the staff can’t wake you up an ambulance will be called and a whole world of fuss will be created around you. An embarrassed Russian man refused to go to hospital because he didn’t need to (but I had to ask) after he had been found slumbering deeply at the end of the line. He wasn’t drunk and he hadn’t been unconscious – he was just one of those difficult-to-rouse types and he didn’t appreciate the over-the-top reaction of the underground staff. To be fair, they had tried all they could to wake him up and they would never risk a mistake with a potentially unwell customer but the man was made to sit on a bench by the platform until I arrived and asked him if he needed to go to hospital. The same question could have been asked by them when he’d told them (repeatedly) that he’d just been asleep.


On stand-by at Leicester Square later on and a cab driver slows to tell me that a woman has fallen on the pavement just a few metres down the road. I drive to the area and she’s surrounded by friends. She’s very embarrassed and admits to being a little clumsy when walking near the kerb. She slipped and twisted her ankle a little. There’s no sign of swelling or bruising and she insists that she can recover with the help of her friends, so I wait in the car until I’m sure she can walk properly.


Acute back pain in a 19 year-old female next. She works in a West End theatre and she’d suffered this kind of thing before but hadn’t bothered to get it checked by a doctor. Now she has a severe ‘stabbing’ pain which is debilitating for her. After ruling out other possibilities I was left with kidney problems or pleurisy as likely culprits but until she gets a proper in-hospital examination carried out, she will never know. The crew take her off and I roll round the corner to complete my paperwork.


I spend twenty minutes writing and restoring my vehicle to a ‘green’ status before I’m called back to the same street as before for a 22 year-old pregnant woman who’s collapsed outside a McDonald’s. She’s had a near-faint and is recovering well by the time I arrive, all of two minutes later. The security guys were worried about her, so an ambulance was called. It still amazes me that pregnancy, regardless of age, provokes such a nervous response from men. I think we are instinctively protective of all pregnant women…or too scared of the possibility of having to deliver the baby.

Be safe.

Tuesday, 9 September 2008

Not dead

Sorry! I've been using up leave days and concentrating on other projects, so I have more than a few postings backed up and waiting to be written. I'll get back in gear by Friday :-)

Xf