Friday, 23 January 2009

Break in

Night shift: Seven calls; one assisted-only, six by ambulance.

Stats: 1 RTC with head injury; 1 Chest pain; 1 eTOH; 1 Pain in side; 1 RTC with chest pain; 1 Assault with neck injury; 1 Unable to cope.

A varied shift tonight, starting with a call to an hotel given as ‘fainted’ with the caller refusing to check the patient’s breathing (sometimes that’s understandable but I find it irritating that people will call and then do nothing to help). In fact, when I got on scene I was shepherded through the place and back out onto the busy main road at the other exit. It was a RTC; a car had hit a pedestrian and now he lay on the ground with a minor head injury. An ambulance was pulling up and a FRU was already there, so I called Control to clarify the situation. I wasn’t sure if I had been taken to a separate call at the same location, such was the disparity of the detail.

I left the crew to deal with it when I was told that no other patient was there and I hoped that nobody was languishing in a room somewhere in need of care.


My son Allan is regularly ‘on the road’ now – he’s doing his three year training programme and he’s let loose with an experienced crew mate as he learns the trade, so to speak. He arrived with his ambulance on my next call and it took two glances before I recognised him! My patient was a 56 year-old man with chest pain who, quite frankly, seemed to be playing up for his audience (a frantic, crying woman and a quiet man, both of whom were with him in the dingy flat).

We took him on board and checked him out but, despite his insistence on pain, our tests showed nothing untoward. His ECG was normal enough but we all know that means nothing if the patient says so. I gave him morphine for his pain but his condition appeared to improve regardless of the short amount of time that had passed since it had been administered.

When we got to hospital, he continued to complain of pain (but louder now that he was being watched) and the doctor, after a thorough examination, decided he wasn’t in any trouble. The last I heard he was being demoted to the waiting room…or the outside world.


Another pretender was my 19 year-old drunken student who was carried over to me by his friends in Leicester Square. To look at the drama they created you’d think a soldier-buddy had been hit during a conflict. As soon as I started to speak to this ‘unconscious’ young man, he grinned and quipped. I wasn’t pleased at all. We were busy tonight and the last thing we needed, especially the hospitals, were comedians who thought an ambulance trip would be funny.

‘I just wanna go ‘ome’, he said in a broad Brummy accent.

But no cab or bus would touch him and this meant I’d either have to leave him with his friends or he’d be taken to hospital to sober up and learn to walk again.

The crew (Allan and his mate) arrived and he was wheeled off to the ambulance. His apologetic friends looked on sheepishly as they realised what a fuss they’d created over nothing.

In the ambulance the student continued to be amusing and almost sober. His behaviour would be clocked immediately by the hard-driven A&E staff and they’d turf him into the waiting area, or outside, depending on their workload and mood.

‘Don’t tell my mum, she’d kill me if she knew’.

Too right, I thought, as would I if you were my son. Shame on you.

I left him to the crew and before I closed the back doors of the ambulance I gave him one last piece of advice, which I hoped he’d remember and act upon. ‘Grow up’, I said.


Around the corner, five minutes later, I was asking a homeless Somalian man why he had called us from the phone box he was standing near when I arrived. ‘I have pain down my right side’, he told me. His doctor had already seen him about this and given him mild analgesics and no diagnosis. He was perfectly capable of walking to the nearest GP surgery or drop-in Medical Centre, if he wanted to wait but he didn’t.

What he wanted was a warm bed but I doubt he got it. His condition wasn’t going to make anyone worry because it was historical and non-urgent, so he too would probably join the queue in the waiting area.


Another RTC later on and again a crew was already on scene, as were the police. Two cars were involved; one allegedly side-swiped the other and the airbags had been deployed in the one that had taken the brunt of it.

A well-spoken young Asian man protested at the recklessness of the other driver; he was the one who’d been hit and now his car looked like an expensive repair bill, even from a distance. The other driver had neck pain and was being checked out by the crew. All I had to do was take care of the emotional man who sat in the back seat of my car until the police had finished their checks, statements and two breathalyser tests – both of which were negative.


I left the crew to deal with an assault on Oxford Street where two men had allegedly fought each other by trying to strangle one another with their belts – very bizarre. It must have been a hoot to watch on CCTV. Now one of them was complaining of a neck injury and had demanded an ambulance. The police were on scene to give sympathy. Or possibly not.


I ended the shift outside the flat of a 95 year-old lady who had called us with an unknown problem. Her door was locked and there was no warden available to help us gain access. I arrived with a crew and we ventured into the secure building. We could hear her from the other side of the door and she seemed fine, although she told us that she was unable to walk, so couldn’t open the door.

After a twenty minute attempt to get the keys or a helpful warden (where are they when you need them?), I called Control and requested police assistance. We can’t break doors down unless there is the possibility of loss of life, so the police need to do it for us in circumstances like this.

When they arrived we discussed the options, found that there were none and the door was forced. A hell of a loud bang rang throughout the building and I don’t doubt a few of the residents were rudely awoken. With an average age of 75 years-old in that place, it’s no wonder we didn’t get another call for chest pains after the noise.

It took one charge at the door and it simply gave in without a fight. The old lady was in bed, shaking from the scare she'd got. She had been warned that it would happen but I guess you can never be ready for it when it does.

All she wanted was someone to give her a drink. She’d been left there all night because her scheduled carer hadn’t appeared, so now she was dehydrated and worried.

‘I think I should go back to the nursing home. I just can’t cope. I’m 95 you know’.

We knew and we all understood. She’d need proper care. She couldn’t manage an independent life any more, the poor woman. She’d even been laid into the bed the wrong way round because when I pressed the button to make the head end rise so that she could drink the glass of water I’d brought over from the little table across the room, her feet went up!

I’ve said this before. We don’t take care of our elderly in this country. We seem to have lost our way.

Be safe.

9 comments:

Mark said...

It's a disgrace the way the elderly are treated in this country. I am still angry, two years after the death of my Grandfather for the poor treatment he received in hospital. Not because the people treating him were incompetent or uncaring, but because of the lack of funding they received, the fact that they were understaffed and the hospital over full.

Anonymous said...

Hiya

Nice blog, I love it.

Just one question:
quote: "I gave him morphine for his pain but his condition appeared to improve regardless of the short amount of time that had passed since it had been administered."

How long does morphine take to work when given IV? I thought it had a sudden unset or have I been misinformed?

thanks for the answer

Mike

Anonymous said...

Mike,

It's not an instant affect generally, it can often take 20mins or so.

James

Xf said...

Mike

James has already given you an answer but I would add that, in my experience, with most patients the onset of effect is 3 to 5 minutes BUT there is a lot to be said anout the psychology behind knowing that you've received a pain relieving drug. It can be as long as ten minutes before they become comfortable, if at all.

Anonymous said...

lovw your blog, just came across it and work as a mesic in nyc usa,,,lots of the same calls. stay safe.

Anonymous said...

I'd bet my last dollar that she doesn't end up in a residential placement after this... they might increase the amount of 'care' she gets at home, but providing she can walk (which after a couple of days of physio in hospital she might well) and is cognitively aware enough not to cause a danger (which it sounds like she was) - I'm betting that she'll be right back home again. Unless of course she can afford to pay for her own care in a home, which then becomes a different story.

And as for understaffed hospitals - may I just say - don't get ill at this time of year. I could weep at the amount of people I've had to send home this week in the knowledge that they didn't really get the care and attention they deserved, because we're all stretched like too little butter over too much toast... grrrr!

Juli said...

Can't help but feel desperately sorry for the 95 year-old who had to have her door broken down, but I do wonder if this was the incident that needed to happen to make her realise she couldn't cope alone. While I agree to a certain extent that we don't take care of the elderly as we should, often it's a running battle to get them to accept that they need any care. I work as an occupational therapist and seem to spend an awful lot of my time trying (and regularly failing) to convince people that they need help, when they're absolutely swearing blind that they're fine, can manage, even when they can't get out of bed on their own when I ask them to show me. I can't force someone to accept help if they don't want it, unless they have a mental health condition which means they don't have the capacity to make that decision. There is no easy answer, it's a fine balance between the right amount of care and maintaining independence.

Ok, moan over!

VA PhireMedic said...

Xf

A good read, as always. Glad to see your son is doing well following in his father's footsteps. However, I must say that we (Americans, I mean) are worse at taking care of our elderly...

Cheers!
LAM

Sewmouse said...

Oh my goodness - running into Dad twice in one night must have been something. Did he give you the old "Checking up on me, are you?" line?

My father and I share a profession, and I know darn well that's the reaction I'd have if he showed up at my job!