Saturday, 7 February 2009

Too cold for work

Night shift: Six calls; one sent packing; one assisted-only and four by ambulance.

Stats: 1 Chest pain; 1 Abdominal pain; 1 EP fit; 1 RTS with shoulder injury; 2 eTOH.

Back on the dark ones and its freezing out there, so I was hoping for as many ‘inside’ jobs as possible but Friday night being what it is, that was going to be unlikely. I only have two to do instead of my usual four because I’m a Coroner’s Court witness next week and so I’ve been stood down for that.

A 51 year-old Albanian man suffering chest pain decided to do nothing about it when he first experienced it last week. He continued to suffer the pain for almost three hours tonight again before his worried family called an ambulance. He wasn’t the type to make a fuss, they said.

He took a paracetamol but it didn’t help, so now he was getting GTN and an aspirin, courtesy of the NHS before being taken into the ambulance for an ECG when the crew arrived. His Q-T intervals were prolonged and that can mean something or nothing, since a small percentage of us have the anomaly without necessarily suffering any ill-effects. I would also have expected him to feel faint if this was his problem. There was no ST elevation to indicate a heart attack but, again, who knows until a thorough check has been done, so off he went.

DIB for an abdominal pain next and the 42 year-old Indian lady, who spoke no English and had to have everything I said (and she said) translated by a younger member of the family, stood in her bedroom clutching the offending belly part. She had no DIB and had never had DIB but when asked on the phone, the 999 caller is bound to say YES to the question and so it goes red.

She had a history of ulcer and that was probably causing her more misery now and yes, ulcers can be life-threatening, so yes, she went to hospital.

Unconsciousness cannot be faked by amateur street drunkards and so I asked the 23 year-old fool lying in the street to sit up because I knew he was pretending. The police were on scene and the two officers had been trying to get him to respond ever since he was seen lying there by a passing driver who called 999. A couple of his mates were there too but I don’t know how long this little charade had been going on.

It took me 30 seconds to convince him that the game was up and as he fluttered to life, the cops gave him an ear-bashing. ‘Sit up or you’ll be arrested for wasting police time’, the taller officer said.

‘You can’t nick me’, said the moaning man as he sat upright.

‘You want a bet sunshine?’ the cop replied.

I like it when police officers adopt a no-nonsense approach; it reminds me that there are still disciplines between people that can be reinforced. Of course, a 'right-minded' person would probably think it unprofessional for a cop to shout at someone like that, but I don't. I think its necessary and effective.

This prompted the young drunk to request the officer's shoulder number so that he could make a complaint. A complaint about what exactly, I don’t know but me, the cops and the crew that had just arrived for nothing, were very cold and not in the mood for this tonight. His parents may have taught him that 'they can't touch you' and so he has lived his life like an ill-behaved child as a result BUT he wasn't spending any more of my hard-earned tax money and that was that.

He saw sense and walked off with his friends, who must have been more than a little embarrassed by his behaviour.

Immediately after that call, when I pressed the green button on my screen, I got another one. I was going a short distance south and when I arrived on scene I was windmilled to a spot on the pavement where an 18 year-old lad was fitting violently. He’d managed to call his friend out to help him on his mobile phone and was still clutching it as he writhed and jerked on the pavement. It took most of my strength to keep his head off the ground – he would have bashed it open otherwise.

Although he was seemingly fitting, he could talk every now and then and could answer questions with a nod and by the time he was taken into the ambulance, his behaviour had become very odd. Now, he may well have been having a partial-seizure – his legs and arms were certainly busy all the time or he could have taken something earlier.

I asked his now growing gang of friends (they were all arriving at the back doors of the ambulance) if he took drugs and they all, to a man, denied that he did. I believed them because they didn’t hesitate and they looked genuinely concerned for him.

The crew fought to get a line in as he flapped about on the stretcher but eventually it was done. He was blued in, still convulsing and with no explanation for it – he had absolutely no medical conditions as far as we could ascertain from him (when he spoke) and his friends (who never stopped).

On the way back to the station I was asked to assist an EMT who was attending a 30 year-old woman who’d been knocked off her bike by a car, which had then sped off, leaving her lying in the road with a shoulder injury. I was told that she needed stronger pain relief than entonox and I went there to give her morphine.

The woman was sitting in my colleague’s FRU, screaming in pain. Her shoulder had either been fractured, dislocated or both…probably both and she was 10 out of 10 for pain. I prepared her for the morphine as she sat in the car and when the ambulance crew arrived, they helped me to complete my task. Again, there were a few friends hanging about – all girls and all cyclists who’d been with her when she was hit.

After a long battle to calm her and relieve her pain, she was taken to hospital with 10mg of the good stuff in her system. She was actually quite chirpy when she arrived at A&E, so it must have been effective. Her constant sucking on the entonox mouthpiece may also have contributed. I think she emptied the cylinder. By the time I left she and her mate, who'd travelled with her, were eyeing up the young men in the department.

Whilst in hospital a ‘blue call’ was received and in came a young man who’d been involved in a fight. He was taken straight to Resus with a deeply cut throat. I went in to see him (being nosey as we all are) and I couldn’t believe how lucky he’d been – his throat had been opened all the way around almost to the back of his head. Someone had used a broken bottle or glass to do it. He also had a head injury which, my colleagues reliably tell me, bled more than the potentially fatal neck wound. The slash had missed all of the vital structures, including his carotid artery, which could be clearly seen through the gaping hole.

I honestly think someone had tried to behead this man. No amount of alcohol or aggression is worth it. Now someone out there may be charged with attempted murder but he will more than likely be done for ABH or less, such is our legal system and the difficulties of proof. To my mind an act so violent as to almost kill someone, regardless of whether it is planned or not, should be sentenced accordingly.

A DOAB at 4.30am when all was just getting quiet and all I had to do was wake him up. He was unsteady on his feet and completely lost, so I directed him to the nearest bus stop. ‘I don’t want to sleep, I just want to go home’, he bleated as I held him still on the pavement. Don’t we all, I thought.

Luckily he didn’t fall down and managed to stagger off in time-honoured fashion.

Be safe.


Anonymous said...


"She was actually quite chirpy when she arrived at A&E, so it must have been effective. Her constant sucking on the entonox mouthpiece may also have contributed. I think she emptied the cylinder."
I've got a question there (which might or might not sound a bit naive, sorry about that) but what do you actually do in those cases when you arrive at hospital? Do you have to take the entonox away from the patient or do they have the same cylinders in A&E??
I needed a lot of the stuff when I had my daughter (and god she took her time) but that was in a proper maternity department and they had supply nice and fresh out of a hole in the wall :-)

Boy on a bike said...

The sooner you are issued with a taser for waking up drunks, the better.

miss emma said...

Great post as usual Stuart!

Just wondering if you could mention this petition in your blog to help get government funding for paramedic students?


Xf said...


We take ours back and let them suck on the hospital's supply. As long as they are happy :-)

Anonymous said...

Yes they have got big, portable cylinders in A&E, when I suffered from a kidney stone I had gas'n air for four hours in A&E and afterwards on the ward as well but it stops working after a while, i.e. it becomes less effective. You still feel a bit dizzy but the pain comes through in the end. Unfortunately I'm allergic to morphine so I needed a lot of different medication to keep me comfortable, I hope I'll never get anything like that again but gas'n air is very good indeed. When I have my baby (I'm 3 months pregnant) I will definitely ask for the entonox straight away :-)