Wednesday, 14 January 2009

All in the head

Day shift: Four calls; one left at scene, three by ambulance.

Stats: 2 Head injuries (1 serious, 1 not so); 1 Purple plus; 1 EP fit

A smelly start to a shift, especially when the memory of breakfast is still in your taste buds, is not a pleasant way to begin the day and my first call was to a hostel in which I would enter a world of waste and toxins.

The crew was with me on this one – a 34 year-old man was reported to have ‘chest pain’ and was also ‘bleeding from his nose’ – a combination that made no sense. Only when we arrived on scene did we get further information from Control that he’d been seen by a crew the previous evening and he’d refused to go to hospital to the point of being aggressive. I honestly thought this would be a waste of time for us – even more so when we were told to wait for police attendance.

The very lovely hostel ‘nurse’ told me that he’d actually suffered a head injury and yellow or watery blood had been coming from his nose. We decided to go and see him before the police got on scene – his aggression may have been due to this head injury, caused, it would seem, by a fall.

We were led to his room and the stench of rot hit us well before we reached it. Inside was a rubbish tip of paper, cigarette packets, empty ‘White Lightning’ bottles and God only knows what else – it lay a few layers deep all over the floor and we almost had to climb over it all to get to him.

He was lying on his side on one of the grubbiest beds I’ve ever seen. At first he didn’t respond, then he spoke but only to dismiss us and say that he didn’t want any help. We could see that his eyes were both black and very swollen and we persuaded him to let us get near enough to carry out some obs.

I stepped onto his bed and made my way around the edge of his mattress – my boot soles were sticking to the surface in places. He had defecated in his clothing and the smell was overwhelming at times so an assessment of wind direction was required every now and then.

I could open his right eye but his left remained tightly shut – it was so badly inflamed that I wouldn’t be surprised to find he’d lost the use of it, temporarily or permanently. The damage to his head was so severe that it looked like he’d been used as a punch bag by someone; none of us could believe that a single fall had produced such injuries. His nose was clearly broken right across the bridge and he’d been bleeding from it earlier – red-stained tissues littered the place around him.

The man was so adamant that he didn’t want to go to hospital that the police, who’d arrived ten minutes after us, invoked section 136 of the Mental Health Act (a place of safety order) to take him forcibly. This is perfectly reasonable if there is the possibility of a threat to life. I couldn’t persuade him to come with us and when I gently lifted his arm to get him to sit up, he threw me off balance. The last thing I needed was a punch that early in the day…or to be lying on that mattress.

He was taken to hospital, still sticking to his story that he’d fallen and the medical team had just as much trouble with him as we did. I left as the doctor attempted to put in a needle in the drug addict's arm. 'You've no f**king chance!', he bellowed at her. He’ll be scanned for a possible skull fracture and bleeding into the brain – I’ll try to keep you posted.

The next call, to a 63 year-old man who was ‘beyond help’, took me to a familiar estate where the crew was just pulling up as I arrived. We went into a small flat which had been broken into by the tenant’s friend when he saw him lying still on the floor. We found the man dead and naked next to his mattress. He was a drug addict and he’d been complaining of feeling unwell for days apparently. Now he was stiff and purple and there was nothing we could do for him. The police were called and I left him to the crew.

When someone has an epileptic fit a paramedic will always be sent, even if that means taking one from another sector. I was sent miles away for a 32 year-old female who was reportedly having multiple fits. I arrived to find a FRU already on scene – he was an EMT, thus the need to send another car with a paramedic on board but he was surprised to see me. He was tending to a woman who was lying on the floor smiling. She was fitting and he was dealing with it. All he needed was an ambulance to convey his patient, so I left the house and told the crew what had happened when they appeared a few minutes later. They are considering allowing EMT's to administer rectal diazepam so that this kind of nonsense stops.

I drove all the way back to my own area and got sent to where I’d just been for another call – this time an 11 year-old boy had a head injury after falling. It took me ten minutes to find the address – I wasn’t lost, I was on scene and inside the estate block but the numbering was a nightmare and the place was a maze of corridors, stairs and ramps. To cap it all, every time I tried to get out of the internal parts of the estate, I found myself locked in by security gates. I was wandering around like an idiot. But I didn’t feel too bad for long because the crew arrived and they too were confused.

After asking several people in the estate, including a young girl who looked bewildered but whose door bore the number we were after, we got a solution.

‘Ambulance’ I said as she opened the door, quickly tying up her robe (I think she’d been in bed asleep...I think).

‘What for?’ she asked, looking at the three of us as if we were mad.

I asked her to confirm the address we were given and she explained that although her flat was the same number, it was in a different block, so we were re-directed to the other end of the building.

‘Can you tell me what to do about my sore throat?’ she asked as we walked off.

I shouted back an answer (gargle with aspirin, if you’re not asthmatic) and she seemed to think I was kidding.

‘No, really…what shall I do?’ her faint, pleading voice cried out from a distance.

Eventually we found the flat – it overlooked where we’d parked our vehicles – the caller could have helped us a little by guiding us in when we arrived.

Her boy was lying on the sofa sleeping. He refused to wake up and answer my colleague’s questions and he played it limp and dozy for a while. He had been sent back home from school with a note for his mother informing her that he’d bumped his head while playing football. The note instructed the mother to call a doctor (by default that’s a 999) if anything untoward worried her – like sleeping. The boy was very overweight and I reasoned that he normally slept a lot anyway (I know that seems cruel but there you have it).

It took five minutes to get this lad to play ball. We all knew he wasn’t suffering the effects of a head injury – he was playing up because his mum was there and an ambulance had been called. I wouldn’t say it here if I wasn’t absolutely sure. You can usually tell when a child is really ill or injured – especially after a head injury. In this case, once the game was up, he sat there chatting away with the crew.

'Do you want to go to hospital then?' they asked him.

'No', he replied.

'He's going', said his mum. So there it is...the reason adults call ambulances for everything - their mum's can't cope with uncertainty.

I left the crew to deal with it and made my way back to a couple of cancellations, including one in which I was taken nearer and nearer to an RTC, only to be cancelled three times. It's frustrating and dangerous.

Be safe.


CatsPuke said...

Note to self: Remember not to read Paramedics Diary when eating lunch. Good read on an empty stomach though. Thanks :0)

Anonymous said...

A section 135? Was he already sectioned then? Or did you manage to find a social worker and magistrate to issue a warrant that quickly?

Unless you meant a 136 - but would a hostel count as a public place?

Something sounds a bit off. It might well have been justified, but that's the law.

Xf said...


A section 136....I've just checked my piece again and see what you mean - should have said 136 or not bothered at all.

I wondered about the hostel being a private place and mentioned this to the officers present BUT I've also been informed that a senior police officer can make the decision even in a private place like that.

What I wasn't going to do was stand there and argue the toss with everyone while the man potentially died of his injury.

Thanks for pointing out my error - now duly amended!

Drip Stand said...

To "Anonymous"....Practical and experienced street coppers will always find a way to make it fit. I usually arrest to prevent a breach of the peace, then arrest for S.136 once out on the street (in a public place) and de-arrest into the care of the ambulance teams. We know they're going to a "place of safety" i.e. the hospital. Not rocket science really!

It's all about doing the best thing for the patient and not worrying too much about the finer details of the law. The law, practically applied, is quite good.

We join the emergency services primarily to HELP PEOPLE, and we do it any way we can ;-)

To Stuart....excellent post (again) mate. I'm halfway through the book and enjoying it immensely! ...and yes, I'm a bobby!

Uncle J said...

Suspicious mind 'just wonders' if reluctance to go to A&E might be linked to reluctance to explain to any 'Authorities' just how (and why)the injury happened?