Sunday, 31 May 2009


Day shift: Four calls; one assisted-only; two conveyed and one by ambulance.

Stats: 1 Naked nutter; 2 Unwell adults; 1 Headache..

Yes, yes… it’s a great job; you get to see the funniest things and the scariest things but rarely do they combine in one call.

A 22 year-old stripped off, ran butt naked down the street in broad daylight, offered his penis to several people (not just women) and then punched a hotel worker in the face before the cops grabbed him, blanketed him and stuffed him into the back of their van.

I was called on the basis that this young man had taken LSD, so I was expecting some kind of hilarity but this I did not see coming. He was so out there that every minute or so he’d go from calm to storm and the merest change in his situation brought about paranoia and hallucinations.

‘You’re going to hospital, they’ll help you there but you must stay calm’, I said through the safety ‘glass’ of the police van. He was sat in the corner with a red ambulance blanket around him (not sure how they got hold of that ‘cos I didn’t provide it). He seemed reasonable but I was wary of him.

As soon as the door was shut, he slammed his fists and feet into it and carried on like an animal in the back of the van. He was handcuffed, so his wrists were suffering as a result of his abnormally violent behaviour.

The cops had asked me to travel with him in the van but I declined their very kind offer and said I’d drive to hospital behind them (the hospital was literally across the road). I wanted to keep my teeth intact.

So, off we went after a few more drug-fuelled agitations and we arrived in about two minutes. He was put on a chair with a blanket around him after standing outside the van starkers while the officers changed his cuff position from back to front (it’s a trust move) but he went berserk again (even though I’d had another soft chat with him and he’d nodded his agreement to behave) and the cuffs were promptly rearranged around his back again.

As he was wheeled into A&E, an ambulance pulled up and a stretcher-borne patient cried out in pain as the crew prepared to move him. This set the naked man off again. ‘What’s wrong with that guy?’ he screamed, writhing out of the chair with two pairs of hands (mine included) trying to hold his shoulders down. He seemed dementedly afraid of innocuous things (LSD has that affect) and so getting him to calm down again took a long time.

Eventually, he was taken into Resus where a nurse began to communicate with him and he responded quite well, after one more thrash around on the bed with a bid to escape chucked in – security arrived but the two cops had it in hand and he was only a danger to those foolish enough to go near his nude flapping feet and hands. His penis was no threat to anyone.

A 92 year-old lady looked unwell as she wandered around the street near Trafalgar Square – she didn’t know where she was and so a local security man called us and I appeared a minute later because I received the request as I sat in the car on the Square itself. See? I eat ORCON for breakfast!

Anyway, she wasn’t unwell, she just looked that way and she insisted on not being dragged to hospital just because she was a bit confused. I decided that, at 92 years of age, she had the right to be a little confused and that her ‘little spell’, as she put it, was probably something she lived with every day. In any case, there was no way I was going to argue with her – old ladies pack a punch.

She asked to go to the nearest underground station because she wanted to go home. She was probably bored with younger people patronising her (to be fair, the security man was concerned and he did the right thing).

I took her to the station in the car, walked her down to the ticket office - arm in arm we went like a married couple (me being her toy boy of course). I asked one of the staff members if he could take care of her from there and ensure that she went on the right train home and he obliged with a smile. I know we are having a hard time with strikes right now but generally speaking the underground personnel in London are good people.

Off she went, thanking me and blessing me (she’d been to church), with an equally broad grin on her face. She’d dumped me for a younger man.

Into a grubby flat in Central London for a 51 year-old man next. He’d had dialysis treatment recently and, according to his wife and friend, he’d come home and sat in the armchair doing nothing and not responding for 24 hours. This, I think, wasn’t quite true because he spoke to me without hesitation, followed my requests when I carried out my obs and even asked his wife for a cigarette. Now, I can’t imagine he’d just sat there 24 hours prior to my arrival without a single fag.

I wasn’t going to convey this man because he couldn’t walk very well and so an ambulance was requested. While I waited, the family dog snooped around, wagging its tail and bringing toys from the kitchen in the hope that I’d play with it. I love dogs but I looked around and thought it was unfair to have the animal in such a squalid flat near a main road – that, of course does not mean that it isn’t loved and properly cared for but a human bit of me wished that it had a better existence than this. All three residents of the place were drug addicts, so I can’t imagine ‘walkies’ were offered that often. I could, of course, be wrong.

When he was inside the ambulance, his wife (who thought she knew me from somewhere) came to the car window. ‘Can you speak to them and make sure they take him to the right hospital’, she said.

‘Well, that’s the crew’s decision’, I said, truthfully.

They’d asked me if he could go the a specific hospital, not too far from their home but the crew had already decided where they were taking him and it was in the opposite direction, although again not too far. I didn’t tell her this because it really isn’t up to me in the end.

At an underground station, a 64 year-old member of staff was suffering from a headache on one side, with neck and shoulder pain. She had a history of hypertension but had been taking her meds and her blood pressure looked fine when I checked it. She hadn’t vomited but was nauseous and she could walk well enough. Her FAST check was negative, so I took her and a colleague in the car to hospital, where she ended up in the waiting area because low-symptom headaches just aren’t high enough a priority these days.

Be safe.

Saturday, 30 May 2009

Where's there's blame...

This statue on Sumner Street, SE1, moves and is quite freaky to watch - even the coat and scarf blow in the breeze!

Day shift: Five calls; two conveyed and three by ambulance.

Stats: 1 Burns; 1 Head injury; 1 EP Fit; 1 ? # Hip.

Summer may be here at last. It’s very warm in London and the place is packed with Europeans cashing in on the sterling/Euro parity that makes swimming across the channel more expensive than flying. Ironically, in these depressing economic times, the surge in visitor numbers may be propping the UK cashflow situation on the black side. Unfortunately, its not slowing the momentum for rip-off taxi fares in the Capital, as I found out when a two mile black cab ride from the Haymarket to Southwark cost me £16 because the driver, on hearing my accent no doubt, decided to take the absolute longest way to get there when I used his service to travel back to my hotel after a night out recently.

I have the utmost respect for these hard-working people but when I am literally taken for a ride, via St Paul’s when a roll over Waterloo Bridge would have done (at a fiver less I would guess), my admiration for them starts to erode. I’ll walk next time.

NPC for the first call of the day. The job was a few metres away from the station and the crew was with me, so the 82 year-old man who’d collapsed needed no more attention than that offered by them.

Then a 37 year-old Brazilian man who worked at a swank restaurant burned his paws on scalding water as he carried a large pot of it upstairs. His knuckles were a bit red and he’d already doused them in cold water for fifteen minutes, so dialling 999 was a bit over the top but I guess he either wanted a half-day or his employers thought they’d be covering themselves somehow if he was seen at hospital, even though every man, woman and child on Earth could have suffered the same minor injury and simply got on with their day. I took him in the car and he slumped across my bag in the back seat as his manager chatted to me about liability.

Another person who thought their call for an ambulance would enhance a claim for negligence was the 42 year-old woman who fell from a ‘treatment’ bed at a beauty salon. She swore that she was knocked unconscious but none of the staff confirmed this to be the case and the bed from which she allegedly tumbled and that she claimed was ‘shaky’, was solid as a rock when I checked it.

She had no bump, no bleeding and no chance of getting money out of the place and I felt a little annoyed that she would expect to get away with fleecing a little business that was probably dying on its feet economically. ‘Don’t worry’, said the concerned looking owner as she got into my car with her young daughter (a reliable witness), ‘when you get back from hospital, we will take care of you’. So, a free hair-do and skin care session was in the air.

At the top of the stairs on the third floor of a hot dance studio, a 35 year-old woman was having an epileptic seizure. She’d been fitting for about half an hour and was jerking on the floor as staff and a friend tried to keep her under control. I gave her IV Diazepam and she went from tonic to rubber in less than a minute. Her breathing rate slowed and her fast pulse declined to a more reasonable pace. Another life saved.

The crew struggled down the steps with her on the chair and I carried the bags as they went. On the way, I looked into one of the dance studio windows as a dozen fit young females gyrated the Rumba (or something similar) in summer-thin cotton dresses and skirts. It wasn’t off-putting in the least.

As the heat began to build during the late afternoon, I went to the rescue of a 92 year-old lady who’d fallen on gravel in a pedestrian area. She had been helped to a bench by a kind Irish girl, who waited with her and even went to hospital with her. The poor old lady complained about pain in her right hip. She had osteoporosis and a history of left side neck of Femur (NOF) fracture a few years earlier. Now, it seems, she had the same problem on the other side as a consequence of her unsure footing.

‘Do you have any medical problems?’ I asked routinely.

‘Yes, old age’, she replied.

Once on the ambulance and sucking merrily on Entonox, her shortened right leg confirmed what was almost a certainty – poor soul.

Be safe.

Thursday, 28 May 2009

Who you gonna vote for?

I've got a few days before I'm back at work and I know you all get bored when I'm not writing! So, given the current political situation (and the fact that North Korea will probably spoil everyone's day soon), I thought I'd give you the opportunity to vote for a new candidate for PM.

Scruffs is standing for election on June 4th (MEP Scruffy) and I want you to give him your support. Simply let me know if you would vote for him (please feel free to include all members of your family).

If he gets enough support, he pledges to abolish all MP expenses and to talk to the local North Korean cats to see if he can dissuade them from launching pre-emptive kitty-litter strikes at the South. He will also increase the state pension and give all Veterans free travel throughout the UK, free gas and electricity and respect from every spotty teenager in the country.

Go for him; you know you have to!


Monday, 25 May 2009


Night shift: Seven calls; one arrested on scene, one conveyed, one assisted-only and four by ambulance.

Stats: 1 Chest pain; 1 Panic attack; 1 Fall; 1 Dizzy; 1 RTC with multiple persons injured; 1 Leg injury and hypothermia.

The last night of this Hellish run of four and I arrive at work hoping for a quieter time, even if I don’t use the word out loud. Another FRU is operational, so I should, theoretically, get less pressure from incoming calls.

Around the corner from the station, a 55 year-old man had chest pain. He’s also vomiting blood but that has been left out for some reason. The crew arrive just behind me and we all troop up to his flat. The Glaswegian alcoholic has been unwell for a few hours, abdominal pain radiating into his chest and the vomiting blood thing. At first I don’t think it is blood in the little basin on the floor but when he chucks up some more, I can see the tell-tale tracks and little clots floating around.

We get him to the ambulance and I stabilise his pain and vomiting with appropriate drugs. He attempts to prove to me that Metoclopramide is rubbish by throwing up again a few times on the way to hospital but his argument is negated when the drug kicks in and he stops in Resus. In fact, he begins to look a lot healthier.

After a few minutes I’d completed my paperwork and I see that the doctor is puzzling over the man’s blood pressure on the monitor – it has gone from 161/99, when I checked it after IV morphine, to 79/56 and that’s not right at all.

I left the medical staff to ponder what may well be a bleed (all the evidence was there for them) after all.

I didn’t do much for the 22 year-old pregnant female who’d had a panic attack at work because she was recovering when I got there. She had a history of this and when she made that clear on the phone after dialling 999 for advice, she was told to have an ambulance ‘check her out’ anyway. We are so cautious and yet we haven’t enough resources to cope, it’s a crazy and potentially dangerous mix.

I spoke with her and did a full set of obs (twice). She was fine. She was a normal healthy pregnant woman, so I left her to it and went back to my station.

Later on, I was asked to go to an incident in which a suspected cat burglar had dropped from one roof level to another – some 20 feet – after the police had spotted him using their helicopter (India 99). He was trying to escape but now he was trapped like a fox, with armed cops on the street around the building and a dog handler in the building. He had nowhere to go and the reports coming from the helicopter suggested that he wasn’t injured but that drop was significant, so an ambulance joined me as I waited for news.

It took less than half an hour to bring the man down in cuffs. I went to see if he was okay and, without a doubt, he had survived that drop. He must have been made of rubber.

Oh, and his reason for being on that roof, above jeweller shops? He was trying to find somewhere to sleep for the night.

A crew beat me to the fitting person on an underground platform. I had driven miles to get to it and the ambulance had pulled in just in front of me a few hundred metres away from the scene. I wasn’t required.

After a quick rest on Frith Street I was called and asked to check on a regular caller who’d phoned from a callbox to say he was passing out. I knew the name immediately and I remember how he should be treated – he is a large man with learning difficulties and a mental age of about twelve. You have to be careful not to upset him because he was capable of violence.

I found him wandering along the pavement. He was heading towards me like a cat to its owner. I put him in the car after hearing about his sudden onset of dizziness and drive him to hospital, where lots of pairs of eyes rolled to the heavens at the sight of him coming through the doors.

‘How long is the waiting time at hospital?’ he’d asked me in the car.

‘I don’t know but I’m sure it’s still pretty quiet’ I told him (and I honestly believed that)

When I sat him down in the waiting area, there wasn’t a seat to spare until someone’s name got called. Oops.

It was a few hours before my next call and it was for a RTC in which a car had ploughed into a Fire Station wall, followed or preceded by a van which had stopped inside the turning area of the station. This was a high speed collision and I’m sure the fire crews on duty were rudely awakened by the noise but at least they didn’t have far to travel.

I arrived as the police cordon was being set up – all traffic was being blocked off and this is a very busy road. An ambulance was already on scene and I had heard one of the crew request two further ambulances.

Fire crews were busily cutting the roof of a BMW, inside which a man sat with a serious head injury. Inside the ambulance sat three minor injuries; two Afghan women and the driver of the car. One of the women complained of a head injury but I could see nothing significant. She had a broken nose and a deep incision to her ankle, which may also have been fractured. As I triaged the patients on board another ambulance arrived and they were taken away, one by one, for further treatment. The ambulance I was sitting in had to be cleared for the head injury patient who was about to be freed of the wreckage.

The van driver had an injured arm and I think every one of these ‘walking wounded’ patients were taken in the same ambulance to hospital because, whether the message relayed hadn’t been clear enough or nobody had heard what was requested, the third ambulance never arrived.

Finally, a call for a naked man in one of the fountains at Piccadilly Circus. At first I thought I was going to come across some drunken moron, splashing about in public but I arrived with the rain starting in earnest, to find a small group of young people protecting a tall, gangly man who was standing in a phone box... in his underpants and soaking wet from head to toe.

One of the youths told me that he had been in the fountain with some other guys and then it had turned nasty and the men had thrown his clothes in and pushed him back in as he tried to get out. He had a very nasty gash to his shin and it went deep enough to be a fracture.

I got him to the car, dressed his wounds and took his temperature. Predictably, he was hypothermic. The police were requested and arrived shortly afterwards. I told them what had happened and they fished about to retrieve the man’s clothes while taking a statement from one of the youths who’d witnesses it all.

The injured man was from a local hostel. He seemed genuinely vulnerable and I think once he’d jumped into the fountain in his underwear, along with the other drunken men who’d been mucking about, he become a figure of fun for them and they’d abused him by chucking his clothes in and then forcing him back, causing his leg injury. They’d all left him like that, according to the youths on scene. He was standing in the fountain, almost fully naked with his leg bleeding badly and not saying a word.

I drive home through traffic that was being diverted by the RTC that I had been to earlier. It’s ironic that my civilian journey can be disrupted by something I had been involved in professionally. It’s actually quite annoying.

Be safe.

Sunday, 24 May 2009

The OK corral

Night shift: Nine calls; one treated on scene, three conveyed (including one to a hostel), one went home and four by ambulance.

Stats: 1 Head injury; 1 ?CVA; 4 eTOH; 1 Oesophageal obstruction; 1 Stabbing.

It’s relentless; the booze-ridden masses and their bad habits descend on the hub of the city in ever-increasing numbers as the weekend progresses.

So, to start with a 28 year-old man gets assaulted whilst waiting in a queue at Tesco’s. Someone cuts in and he objects – his reward is a bottle over the head. It shatters and the force of the blow drives a sharp end of the shard into his skull, so he’s effectively been stabbed by it.

By the time I get there, the police are on scene, his wound has stopped bleeding and the assailant is long gone. The cops give him an honest estimate of the possibility of catching the thug – practically nil – and the man (both he and his girlfriend, who is with him, are Polish) accepts the statistic and simply replies ‘I knew what I was coming into in Central London’.

I conveyed him to hospital in the car. He was perfectly stable, hadn’t been knocked out and the wound was now dressed and bandaged. I, like my FRU colleagues, have a well developed sense of the chances of getting an ambulance to a job like this in fair time and I judged them to be very low.

At a care home, an 85 year-old man has ‘stopped responding’. I can’t find staff to guide me properly to where I need to be, even though they have called this in as an emergency, and I wait until someone bothers to appear with rushed instructions of where to go before I can make up for wasted seconds. Then I have to mess around at the floor where his room is located until another staff member puts in a word about which room he might be dying in. It’s bloody ridiculous.

He’s lying flat on the bed and he’s not well at all. ‘How long has he been like this?’ I ask the ‘nurse’ or ‘carer’ or whatever she calls herself, whose been standing over him – literally - and doing nothing else. She fumbles with an answer or anything like an explanation to help me out and then she has to leave the room entirely to get his records so that I can find out what exactly might be wrong with him.

He’s breathing a little noisily but his airway is patent and his obs are normal, apart from a deficit of oxygen giving him a low sat reading, but after a few other tests, I discover that his right side doesn’t want to play any longer and I suspect he’s having a stroke. I have nothing else to go on of course because the people who work there seem to know next to nothing about him; the ‘nurse’, ‘carer’, whatever, had to go to the door where his name is printed on a large card, to tell me his surname.

The crew arrives and I explain the situation. He’s on oxygen and it has helped to wake him up a bit but he’s not doing well otherwise and they take him away rapidly.

The next call was a NPC for a bleeding PR; the crew was arriving at the same time.

An emergency dash for a drunken 33 year-old female resulted in a twenty minute check over in the back of the ambulance and a freedom pass to go home in the hired Limo that she and her friends had organised. She would stagger and vomit all the way home and, of course, her friends swear she’s only had a few.

Never judge a book by its cover – especially if the book is a 6ft Russian doorman made of steel who gets his mates to dial 999 for an ambulance because he’s eaten something and it’s now stuck in his craw! Okay, it’s a frightening thing if you’re not used to it but it’s common and not really life threatening. He had an uncomfortable feeling half way down his gullet and that was about it but this had been converted to ‘difficulty in breathing’, as usual and so I rushed to save his life.

I cancelled the ambulance because I had a plan. I asked him to go and throw up. He did and five minutes later he was a new man – all smiley and relaxed... with a clear oesophagus. Little did I know I’d be back at this club for an entirely different and much more serious emergency.

A small crowd of people gathered around a 19 year-old girl who was known to be diabetic. She’d had a few drink and a couple of ecstasy tablets and was behaving strangely, as if she were drunk... so her mates logically concluded that she was hypo, completely ignoring the other, more likely factors contributing to her lolling head, vomiting and confused conversation. Clever, eh?

I did my BM and it was a little high – not a lot, just a bit. I gave my honest opinion and her friends didn’t want to agree.

‘She’s drunk’ I said.

‘No, she only had a few’, they said. I’m thinking about getting a little sign to stick on my jacket, it will read ‘Don’t tell me he/she’s only had a few because I’ve heard it before and it’s boring’.

She and her mate went in the car to hospital. Believe it or not, her insulin was being brandished about and I think one or two of her mates were preparing to use it before I arrived.

A man lay in the street getting very cold in the smallest hours of the morning but I didn't see him and I almost drove past but a police van stopped beside my car and an officer pointed out the human debris. I went over to check him out as the officer asked him questions like ‘what are you doing?’

He was from the local hostel and so we picked him up, walked him to the car and I took him home. It took a couple of minutes to get there around the one-way system but when I went in with him the reception staff asked if he had any medical problems. They obviously assumed I was going to dump him with them if he had medical needs. ‘No’, I said. ‘you’re safe. He’s drunk and he’s now yours again’. They welcomed him like a long-lost son.

This drunken Irishman had even offered to pay me for what he believed was his cab home.

I rushed back to the club where the doorman had worried about his un-swallowed food to deal with the first of many fight casualties of the night. A 25 year-old had been stabbed in the head and was lying, bleeding on the road. Plenty of cops were there when I arrived and an ambulance had just pulled up with a trainee crew and their paramedic supervisor.

The man was conscious and had no other injuries except the deep wound to his forehead and various large bruises around his eye and ear, where he’d taken a beating. This was a potentially life-threatening injury, so he was treated as rapidly as possible and loaded onto the ambulance.

As I prepared to leave the crew to it, a call came over on the police radio reporting another incident further up the road – this time it sounded like someone had been shot, so I ‘greened up’ and asked if I could help. Control sent me to it but the location given matched the area in which another person needed help for a lesser reason.

I had seen the police cars fly past in the direction of the supposed shooting and my MDT report stated ‘caller said we have killed him’. It was a Red1 call for a cardiac arrest, so all of those elements indicated a serious call. I headed to where the given location was and saw one police vehicle, three armed cops and a body lying on the pavement. What I didn’t see, and fully expected to, was a taped-off area, bystanders being ushered away and plenty more officers.

Then one of the cops approached the car with a fairly relaxed swagger. ‘It’s nothing, he’s just drunk’, he said. Instantly I knew I was on the wrong call (I was later to find out that this call hadn’t even been made). I was stuck here though because there was a young man lying unconscious on the pavement. All around him was a pool of red liquid which turned out to be wine.

The crew was on scene very quickly and I handed over but I had to stay with them because the guy’s BP was stupidly low and he needed fluids. Once I’ve started a treatment like that I have to stay with the patient to hospital, so I was going nowhere else.

Another FRU had turned up at this scene, with the same confused location details. He’d been put on an RVP for the shooting and I directed him to where all the police cars had gone, further up the road. Somebody may as well be doing something useful, I thought.

The shooting turned out to be a pistol-whipping that had been dealt and the assailant was still at large with the gun, so a radio broadcast warned every vehicle to stay away from the area, although they neglected to say how long for and I found myself back there a few hours later as I drove for home. Luckily, I drew no gunfire.

Be safe.

Saturday, 23 May 2009

Fit to go home

Trying to disguise yourself against a background that is hopelessly at odds with your camouflage just makes you stand out even more.

Night shift: Five calls; one refused, two conveyed and two by ambulance.

Stats: 1 Dying swan (eTOH); 1 Asthma; 1 EP fit; 1 Back pain; 1 eTOH.

First call of the night is for a 35 year-old man claiming chest pain. A Motorcycle colleague is on scene and very quickly an ambulance joins us. He is writhing about in the street with his two lady-friends worrying over him and I suspect he is doing more in the way of performing than dying.

He staggers and collapses on the way into the ambulance and his weight almost pulls two of us down as we support him but he doesn’t need this help, he needs to grow up and drink less.

The fact that I now have a brake light and tail light out on the car means that for the next four hours of the shift I am sitting at station waiting for the RAC man to appear.

As soon as I am road legal, I get a call to a 62 year-old man having an asthma attack in the street. Two PCSOs are on scene with him and I know him well; he is a regular caller who lives locally in Soho. He goes to hospital frequently with breathing problems that are either real or imagined, depending on the day, the weather and the need for attention. I don’t doubt he has health problems but he definitely isn’t in danger here - I nebulise him anyway and take him to hospital in the car, where he promptly bursts into tears and I feel ashamed for not showing him enough compassion.

As I wander back into the West End, I watch a Pedicab full of drunks go out of control and steer directly into a post on the pavement. The loud bang is followed by human spillage as three large and stupidly drunk men are thrown into the street by the force of the unexpected halt in motion. The driver follows suit and they all stand up eventually looking dazed and grinning like idiots. I don't even think the smiling idiots were offered a refund. It’s only a matter of time before one of these things kills someone.

A trip north took me to a 39 year-old man having a fit outside a pub. His friends were with him and he’s already had four seizures, I’m told. At first there is a wee bit of aggression towards me but it all melts away as I refuse to be drawn and decide to behave myself like a professional. So, I carry out my obs and watch as he has another fit.

The man is epileptic but he’s also been drinking a lot tonight, so the possibility of my giving him Diazepam is rendered void. I cannulate him when he relaxes again and reassure everyone around that he will be fine but I need an ambulance for him because he could fit again at any time.

The voice on the other end of the radio tells me there is nothing to send except a vehicle miles away and I contemplate the long wait while I attempt to keep him stable without drugs. Miraculously though, he recovers fully and in no time he’s begging not to go to hospital, despite his friends insisting that he does. He hasn’t fitted for the past 20 minutes and he looks well enough to make a decision for himself, so I do as I am asked and cancel the crew when they arrive on scene, explaining the reason why to the attendant.

I do the necessary paperwork and remove the cannula from his arm. He thanks me and has a smoke after signing on the line. Hid lady friend kisses me and hugs me like I’ve known her forever and it all gets a bit awkward but it’s nice because that’s two shifts in a row now where I’ve genuinely felt appreciated – it doesn’t happen often and it balances the scales for me on nights like these.

A 24 year-old man claimed chest pain until I arrived and suddenly the ache was nowhere near his chest. He had back pain, felt hot and couldn’t sleep. The staff at the hostel he was staying at called on the basis of his initial complaint and now they looked sheepish. This would have been a Green category call except for the lie (or exaggeration if you want to be kind). The crew took him away and he sat the night out in the hospital reception no doubt.

The police called us for a 19 year-old German man who was unconscious in an alley. I woke him up and got him to his feet, proving, in a few seconds, that he wasn’t unconscious. He was drunk and rude. He spat a lot and didn’t seem to care that his goblets were often heading our way. Even the police officers had to remind him that they were present, especially when he decided to remove his trousers in a public place. I don't know if his alcoholic brain was telling him he was going to bed or going to the loo but nobody wanted to find out.

There was no ambulance for this man and I thought about the wait I’d have with three police officers who had better things to do, so I conveyed him myself in the car, warning him not to spit and to use the clinical waste bag I’d wrapped around his neck for such adventures (including vomiting if he wanted to). He now had an orange plastic bib on and he fell asleep straight away. I had an German adult-baby in the back of my car, so the journey was uneventful.

I woke him up at hospital, got him into a chair and that was that.

Be safe.

Friday, 22 May 2009

In excess

Night shift: Eleven calls; one treated on scene; two assisted-only; two conveyed and six by ambulance..

Stats: 1 RTC; 1 Asthma; 6 eTOH (most with head injuries); 1 Cut lip; 1 ? Drug overdose.

It’s Friday night, the weather’s warm and it’s a Bank Holiday weekend – obviously a recipe for disaster and upward of 4,500 calls says it all. Happy holidays and alcohol mix to give us a subtle blend of work, work, work. Hey ho – it’s a living.

But I started with a short-lived VDI check when a call came in for a RTC in which a motorcycle had collided with a bicycle. I requested a delay because I had barely sat in the car and wasn’t quite ready but the call was upgraded to a Red1 – apparently a 12 year-old boy was in cardiac arrest on scene. So, I set off half-checked and made my way to the place where this dead boy was supposed to be.

I got there and a crew was on scene. They were dealing with a very alive young boy of about eight or nine. He was lying flat in the road and a few women were milling around anxiously; one of them was his mm.

He had been hit at 30mph by the motorcyclist when he and his friend had allegedly darted out on their cycles, straight into a busy road, from their estate. The motorcyclist managed to swerve away from boy-rider number one, but hit boy-rider number two. Both of them (cyclist and motorcyclist) went flying. I was asked to attend to the 49 year-old man who sat against a wall looking worried (he still thought the boy had been killed).

I examined him, reassured him and went back and forth doing errands wherever I could. He had an injured scapula, so I put a sling on him and waited for a second ambulance to convey him to hospital. I waited and waited.

After a delay and by this time the boy was ‘packaged’ and ready to go, I decide to take the injured motorcyclist in the car. He was in pain but stable; he had no neck injury and complained of nothing else. He agreed to get into the back seat and I sped behind the ambulance as we headed for the hospital on blue lights.

There had been a bit of a crowd of people around the scene and I don’t think the motorcyclist was popular, so it was best to get him clear of it sooner rather than later.

Next on the menu, a 68 year-old man having an asthma attack at his hostel. He’d recently been diagnosed with a chest infection and his inhalers had brought some relief but not enough, so I nebulised him until the crew arrived to take him away.

The first drunk I encountered was described as ‘incontinent of urine’ outside a pub, which kind of says it all. The 52 year-old man was with people he had befriended earlier in the evening when he started his drinking binge. He told me he had bowel cancer and was trying to forget through booze. Fair enough. He became tearful at times and his mates were very sympathetic and helpful. One of them, a tall woman in her fifties decided she wanted to marry me and landed a kiss on me as I stood in the road signalling the ambulance in. The crew were highly amused and as the man was taken into the ambulance, my new girlfriend pawed at me some more for attention. I bid my farewell as hastily as I could because it was all getting embarrassing and I’m quite shy really…ask anyone.

A call to a 25 year-old woman who lay on the pavement until I arrived then miraculously became conscious, left me standing with the security men as she walked off in a huff with her equally drunk father. ‘Nobody cares about me!’ she shouted over and over again. Dad seemed unfussed. I wondered why on earth she’d think that.

No patient contact (NPC) for the 30 year-old pregnant woman who fainted. The crew was on scene and I wasn’t required.

A Green call to a 26 year-old woman who’d cut her lip and it ‘won’t stop bleeding’ led me to a no-trace because she was nowhere to be seen. Then she approached me with her friends (all drunk) and her boyfriend insisted that I take her to hospital. She had the world’s smallest incision on her lip and it had stopped bleeding long ago. The only way it would seep again was if she smiled too much, so I stuck a strip across it to close it off and she was happy to continue homeward. Her boyfriend wasn’t pleased because, as he eloquently put it, ‘I won’t get a shag now’. No, I thought… you probably won’t.

Sometimes only a few drinks can cause problems with your body and you end up wobbly-legged and in and out of consciousness. I explained this to my latest friend, a 30 year-old woman who definitely looked much younger, as she lay in her hospital bed recovering from her little adventure in a club toilet a few hours earlier.

She had been knocked over by a guy in the club and fallen onto a table, where she was knocked out for a minute. He didn’t bother to check on her or offer to pick her up. He didn’t even apologise apparently, so her friends took care of her and I found her in the loo with a very small cut to her head. She was groggy but that could have been the booze, although she will hate me for saying that.

At first she was fine with me and when I was told there was no ambulance for her, I opted to take her and one of her mates in the car but she quickly fell asleep on me, again and again, refusing to lift her head to acknowledge me, let alone her body off the floor to walk. So I struggled with her until I could no more and she got what every alcohol-unconscious person gets – a needle and fluids, which temporarily woke her up. I say temporary because she was with me for no more than a minute at a time before flaking out again.

I had to have the biggest security guy and a couple of her friends help me drag/walk her toward the exit – it became a saga and I told her off more than once (but I’m sure she’ll understand). She wasn’t heavy in mass, she was just dead weight. At one point the big man pulled her up in a most undignified manner, which she strongly objected to – I couldn’t blame her but there was no way she was staying on the floor for the night. ‘Just give me two minutes’, she’d say after each stagger-collapse attempt. It was like the Great War, we were gaining ground but by God it was slow going and we were losing men along the way, so to speak.

‘Just another two minutes’


Eventually one of her more dominant mates talked her into behaving and she managed to get herself, with a lot of support, to the car. I sped to hospital and deposited her there as quickly as I could. I was concerned about that head injury, even though my instinct told me it was minor. It was convey or wait for a long time, so I conveyed.

Now, she was chatting away to me in hospital some hours later. Fully recovered and quite sure, without reservation, that the drink had nothing to do with it. ‘I’m never going to drink again’, she says. Hmm, I’d like to believe that but I don’t smiler.

I seemed to be battling my way through this shift and my next call, to a 33 year-old man who had cut his hand attempting to break into his home through the closed window, quickly deteriorated from a solo attempt to get information from him as he lay in the doorway, with his mum and a very large dog in the background. I asked him about booze and drugs, as you do but he was unwilling or unable to tell me anything – he just lay half-in and half-out of his home. Mum was useless – ‘come on son, tell the man what’s wrong’, she’d say quietly and gently, like she was coaxing a song from him.

The way this man was behaving and his pin-point pupils had me suspicious about his night-time habits and whether drugs were involved. ‘Does your son take drugs?’ I asked his doting mother. ‘Well, yes he does’, she replied. At last, I thought direct honesty – something I could work with.

‘What does he take?’


I tutted very loudly in my head. Or possibly out loud. I can’t remember.

Just as the crew pulled up, the man began to get feisty and I found myself being grabbed at. ‘F**k you!’, he spat. His aggression was unprovoked and without warning. He scratched my arms as he clawed at me again and again. Then he tried to wrap himself around my legs – I absolutely hate it when they do that. I managed to break free but my unfortunate colleague, who was in the process of getting mummy to lock the dog away, got a superhuman hug around his ankles as he stepped over the wild man.

The level of aggression rose sharply and the three of us were having a hard time controlling him. Meanwhile, in the background, mum’s soothing voice was having no effect whatsoever. We were getting assaulted and she was trying to give him love.

I had Narcan at the ready and my colleagues held the man down as I approached to inject it but he saw the needle and flew into a rage, throwing off the strong hands that were on him. This little guy was enormously powerful when he got mad. Mum almost walked into the needle as I held it away and out of the man’s reach – I nearly stabbed his mother. That would have got me dead I think.

We’d had enough, so I called for police backup and they joined us within a few minutes. We managed to get a BM from this man but not without a mammoth struggle in which my fingers were almost fused to his hand by his unrelenting grip. I thought he was going to dislocate them; it took the combined force of both my colleagues to prise his stupid hand open so that I could feel them again.

The cops looked fed up – they’d had a night like this too and they attempted to calm the man but he was unwilling to behave. There was definitely a drug at work here but we didn’t know which one, so he was going to get Narcan as soon as we were able to give it.

His hand was cut but it was a minor wound and, considering the trouble he was giving us, not worth the worry. He was physically hauled to the ambulance, kicking and flailing all the way. Then he collapsed into a heap on the floor like a rag doll.

‘Madam, can’t you speak to your son with more authority than that?’ I asked after getting very annoyed by her continued mild manner in the face of the abuse we were all being served by her baby.

‘Mamma’, the man would say every now and then during his violent outbursts.

‘I’m here. Please don’t embarrass me. They are trying to help you’, she’d almost whisper. This woman seemed to have only one volume level for her voice and at 33 years of age, he should have been living somewhere else or at least doing as he was told.

When he quietened and went to sleep, I jabbed him in the arm and he got 400mcg of Narcan – just in case.

The journey to hospital was uneventful and he arrived awake and compliant. I didn’t know whether to feel sorry for his mum or angry with her softly-softly attitude. Maybe its me and the way I was brought up but my mother would have murdered me if I’d behaved like that – at any age.

Another NPC for a drunken 20 year-old with a minor head injury at a club, the crew was on scene just ahead of me.

People who abandon their drunken friends in the street are a disgrace to the whole ‘mates’ ideology. A 25 year-old man was found lying on the pavement with a head injury (caused when he fell) and a complete lack of interested buddies. Apparently, according to the MOPs who stopped to help him, they buggered off and left him to dry out in the street. Nice.

He remained unconscious while I waited for an ambulance. The MOPs had left the scene and I was alone with him in this quiet little street at 4am, so I crouched down next to him, monitored him and caught up with my paperwork. There was nothing else for me to do. He had a blanket on him because his temperature was low but, apart from that, his obs were normal and he was breathing.

I’d spoken to his father on the phone because one of the MOPs had used the man’s mobile to call him and explain what was going on. The other had rolled him into the recovery position and I was very grateful for their help.

When the ambulance arrived and the crew started to check him out, he suddenly went from not there to wide awake. Typical.

My last call of the night was a reassurance job really. A 30 year-old French man staggered back to his hostel with a crowd of mates after a night out and collapsed in the hallway. Even though he was patently drunk and nothing else, they called an ambulance because ‘he hadn’t drunk much and maybe his drink had been spiked’, as one of them said.

See? You have to understand that alcohol is a poison in excess and the body decides what excess is, not you. Sometimes you can tolerate a lot and sometimes you can’t. It’s got little to do with eating prior to consuming it (although that does slow down absorption); it’s about the state your body’s in at that precise moment. You could swallow a single glass of wine and it could knock you down. That’s when you and your friends chorus ‘he/she/it is never usually this bad. He/she/it has only had a few’.

I left the man in the care of his friends after confirming their worst fears. ‘He’s drunk’, I said.

Be safe.

Tuesday, 19 May 2009

Secret diabetic

If this had been done in the UK, the poor doc would probably be in court being sued by someone. They still have a sense of 'do what needs to be done' in Oz and for that I applaud them.

Day shift: Six calls; one assisted-only, three conveyed and two by ambulance.

Stats: 1 Head injury; 1 hypoglycaemia; 1 Amnesia; 1 Nicotine overdose; 1 Sprain ?#; 1 Headache and vomiting.

I’m writing this on my break in an effort to keep up to date. Hopefully, with four nights ahead of me over the weekend, I can keep on top of this writing lark.

So, a 50 year-old Canadian woman tripped on a kerb and landed mostly on her head, where a large bruised bump now resided. She hadn’t been knocked out and when I arrived she was with her family and a white van man who’d very kindly stopped to help out – he stuck around to assist me and I thought that was a nice gesture; he wasn’t in my way and he seemed genuinely keen to do his best, even though his van was being threatened by a lurking (and equally keen) traffic warden.

The lady and her family were on their way to Windsor but now that plan had been changed for a short trip to A&E. I didn’t take her in the car; her age and that massive bump dissuaded me. I found out that she had AF and other medical issues, so it was best to let an ambulance crew take her away. All I had to do was carry two of her relatives in the car to hospital.

She had a couple of stitches put in and went upstairs for a scan later on but I’m sure she’ll be fine – my concern was that her fall hadn’t purely been mechanical.

The next call was for a 30 year-old female who’d been behaving abnormally at work. Her colleagues on scene told me that she wasn’t walking properly and was confused. I found her on the floor but more than willing to sit up – in fact, she didn’t want the fuss at all but she seemed to be drunk. After ruling out alcohol and drugs, I carried out my obs until a crew arrived. I was about to cancel them but as they were on scene, it now seemed logical to have them carry out further checks.

I did a quick BM as the crew chatted with her and as the meter counted down to show the result, my two colleagues and I watched it. Her blood glucose was only 2.4 – she was hypoglycaemic.

She was given Glucogel until we were ready to move her to the ambulance. Every time she stood up, she staggered and lost her balance. She seemed more aware now but her general behaviour was still abnormal, so the crew injected her with Glucagon in the vehicle.

I found out later that she was a diabetic but didn’t want to admit it in front of her colleagues – she told the crew when she was alone with them. Although I understood her embarrassment, I feel she had played a dangerous game and that she may well have ended up unconscious on that floor if not for the quick-thinking of her friends.

Another little mystery call to a hotel next, where a 67 year-old Scottish man had shuffled in and become agitated when he realised he didn’t know where he was. The staff knew he was a resident because he’d checked in the day before and had been taken to hospital for reasons unknown. Now he was up in his room with a staff member and I walked in to confuse him even more.

‘What’s your name?’ I asked.

‘I don’t know’, he said.

‘Where are you now?’

‘I don’t know’.

That was pretty much the basis of the whole conversation.

I got his name from the hotel staff and I did all my checks, none of which showed that he had an immediate problem. He didn’t know where he’d been all night and I was told that he carried a lot of cash around with him, so I wondered if he’d been assaulted and robbed but that didn’t pan out because he still had all his money and he had no injury (that I could see anyway).

I took him to hospital in the car while he mumbled about not knowing anything and how afraid he was. I gave him whatever soothing sympathy he needed until I got to A&E, where the nurses recognised him.

‘What’s wrong with him?’ one of them asked.

‘Amnesia’, I told her.

A grin spread across her face. She obviously didn’t buy it and, to be honest, I was unsure because he’d managed to find his way back to his hotel, regardless of the fact that he didn’t know who or where he was.

I left him in their care, sitting on a chair in Minors; he looked apprehensive. ‘You’re not leaving me, are you?’ he asked worriedly.

Every now and then a call will come in and it’s a piece of cake to deal with – the kind of call that really didn’t need an ambulance but was in that grey area where nobody else will do.

I walked into the reception area of a very posh block of flats near Park Lane and the Concierge took me to the lift.

‘The second floor’, he said.

‘Which flat number?’ I asked as the lift doors began to close.

‘The whole of the second floor’, he replied as they shut in his face.

Now, that is flash.

I stepped out into a huge marble-floored flat and was taken by a family member to a 62 year-old woman who had suffered hyperventilation, shaking and palpitations. She was in bed and looked fully recovered. She beamed a smile at me and I asked her if she felt okay. ‘Yes, I do now’, she said.

She had opened what she thought was a packet of chewing gum and taken one out. As she chewed on it, she began to feel unwell, as described above. Her worried family called NHS Direct who, inevitably, told them to dial 999.

She had never smoked in her life and her body had simply reacted to the nicotine contained in the Nicorette gum she had been eating. For a non-smoker, the gum will cause problems, especially if it is chewed continuously – she had been given a fright but now she was recovering well. All her obs were normal and I left her in the care of her family, who will probably be much more cautious about where they leave their stuff in future.

A 23 year-old German girl stumbled down the last few steps at an underground station and twisted her ankle. She continued her journey until the pain and swelling were too much and she could no longer walk on it. An ambulance was called and a CRU was sent from Frith Street, where he, the MRU paramedic and I had been holed up drinking coffee. I was asked to convey the patient a few minutes after he’d arrived on scene.

Her ankle was hugely swollen and it looked like a grade III sprain or a fractured lateral malleolus (see, I know stuff). She’d have to go to A&E and have an x-ray to confirm one or the other, so we hopped her to the car up three flights of stairs and an escalator. She was tall, so a lot of pressure was placed on my suffering shoulder but it was the most efficient way to get her out of there and an ambulance was an over-the-top response for the injury, which she bore very well considering the discomfort she must have felt.

I wheeled her into casualty after she’d reclined in the back of my car for ten minutes during the trip. She had a history of this kind of injury and she didn’t seem at all surprised that it had happened again. Next time (and there will be one), she will probably stop and get help before it becomes too much for her.

My last patient was a migraine-suffering 56 year-old woman who’d been out for the day with her husband when she began to feel ill. She had the worst headache she’d ever experienced and was vomiting. I take this stuff seriously because at her age and given her history, a major condition can be masked by a known component like migraine. I took her to hospital quickly in the car, husband in tow, and we were there in less than five minutes – it would have been a longer wait for an ambulance. Her vital signs were all normal and she didn’t have any other problems, such as visual impairment. Her FAST check was negative.

She vomited constantly in the car and I considered Vertigo as a possible suspect for her troubles, although she denied ever having it before and the tell-tale dizziness didn’t exist, unless she simply didn’t want to tell me about it. Other, more serious problems, such as tumour, could cause these signs and symptoms.

She was sent to the waiting area, where dozens of people sat or milled about; it was like a Saturday night. She sat on the wheelchair I’d taken her in on, with her husband at her side and she vomited over and over again. I felt very sorry for her and asked the triage nurse if she could see her quickly. I’m sure the other non-vomiting patients wouldn’t mind...

Be safe.

Monday, 18 May 2009

Dead drunk

Day shift: Five calls; one refused, two conveyed and two by ambulance.

Stats: 1 RTC; 1 Headache; 1 Hyperglycaemia; 1 Minor burn; 1 eTOH.

It feels like a long time since I last wrote a post up and I guess the stresses of getting the new book out on time (it’s late I’m afraid) have displaced me from my usual habit of working, writing and posting. But I’m back again and before I launch into the hated night shifts to come, I have a couple of daylight shifts to write about.

Two cyclists collided on a busy road and one of them came off and crashed to the ground, sustaining minor injuries to his leg and elbow. He also had a nasty looking bruise to his left lower abdomen, just about where his spleen sits, so I took him to A&E to get that checked out. It became more painful during the journey, so it was probably wise to get a second opinion.

Then a 25 year-old man had his colleagues call an ambulance because he had a headache, felt dizzy and couldn’t see properly. Now, I crow on about how much time is wasted on calls like this but, like everything else, you can never rule out a possibly serious condition, even with the most benign signs and symptoms. I have dealt with patients before who have presented like this – especially the vision thing – and, despite their good health and youth, they have surprised everyone by suddenly deteriorating as the result of a neurological problem.

In this man’s case, I had the same suspicion – he was young, healthy and had never had cause to call an ambulance before. Now he had this frontal headache and visual disturbance, so he was taken to hospital for examination.

An observer – Ana – joined me for a short ride-out at this point in my day and as soon as she got her jacket on, we were on scene for a 62 year-old alcoholic man who’d been found collapsed in the street. Police were present and the man on the ground remained slumped but conscious at their feet. I didn’t recognise him, so I assumed he was new in this part of town.

He had been drinking but hadn’t eaten for a few days, he told me. He is a type 2 diabetic and when I checked his BM I found it to be quite high (up in the lower-mid twenties). He had two out of three from the classic triad for hyperglycaemia; polydipsia, polyuria and he phased from gentle as a lamb to vociferous annoyance.

I arranged for him to be visited by someone from London Street Rescue, so that he could be given shelter and food and an ambulance arrived to take him to short-term sustenance.

A call for a burned eye turned out to be a very minor thing indeed. The 23 year-old female works in a café and managed to get hot coffee in her eye (mostly her eyelid) when she bumped into a colleague carrying a cup of the stuff. When I arrived, she was in a small room where water had been provided to douse the injury just after it happened.

She was a diminutive Italian girl with a sense of humour about the whole thing and we both agreed that she should get her eye checked out at A&E, even though it really was an insignificant burn and her eyelid was hardly swollen. As I packed her and her friend into the car, I made sure that the offending cup-carrying waitress who’d caused the injury felt very guilty about it. Smiles were thrown back and forth and the day seemed brighter. Thank goodness for those with a sense of fun.

Poor Ana only got to see the worst of a day shift in her few hours out; a drunken alcoholic at the start and another one to end the day. The Lithuanian man had been lifted off the ground by police after the public had called an ambulance for a supposedly dead man on the pavement. The Red1 category soon changed to amber when it started to dawn on everyone around him that he was probably just drunk. The clue was the ‘? Drunk’ statement given over the phone I think.

He wasn’t interested in my help and refused to have any obs carried out, so the police officers agreed to take him in their car and drop him off in a local park so that he could sleep it off.

After I dropped Ana off, I heard another call go out to one of the MRU paramedics; an unconscious man was lying in the street. The location given was the same area that the cops had dropped off our last patient. So, the drunk Lithuanian was once again generating tax-coin calls and once again we had no choice but to send a solo and an ambulance to him, even though I called in to explain who he was and that he’d refuse anyway.

Meanwhile, throughout the day, Tamil protestors were causing absolute chaos. Parliament Square and the surrounding roads were shut down and my short run back to base became an epic journey as traffic ground to a stand-still – every bus on the Whitehall route had been diverted and so it took me, and hundreds of other homeward-bound people, much longer to get home. After twelve hours on duty and an hour each-way commute, the extra hour or so that I was forced to endure as a result of this disruption was not sympathetically received I’m afraid.

Be safe.

Sunday, 10 May 2009

Thursday, 7 May 2009

Crash dummies

Night shift: Seven calls; one refused, one NPC; five by ambulance.

Stats: 2 Falls; 1 Head injury; 1 Chest pain; 1 EP fit; 1 Fractured femur.

I find, as do my colleagues no doubt, that an entire shift of run-of-the-mill calls can be lifted by just one interesting job. Obviously the poor patients don’t have this perspective but from a clinical point of view, we all want to be doing what we’re trained to do and a serious injury or illness can bring about a modicum of relief from the stresses of routine.

But it was all much the same to begin with; a 75 year-old man who’d collapsed at home and couldn’t walk after a fall several days earlier crawled into the lift, took it to the ground floor, crawled out into the lobby and called for help, triggering a 999 call for ‘chest pain’. In fact, he had bad leg pain and may well have damaged his hip when he fell at the beginning of the week.

It wasn’t his injury that surprised me when I walked in, it was his breath. He was sitting on a chair which had been given to him by a neighbour - I’d been signalled in by a tall man at the entrance but he didn’t come inside with me and I knew why when I met my patient.

I could barely understand what he was saying because he had very few teeth and those left behind in his gums were rotten and blackened. He had the worst case of ANUG (Gingivitis) I’ve ever encountered and the reek of rotting flesh that greeted me with his first cry for help almost knocked me down. It certainly made me step back and my brain immediately associated the stench with death, although I reminded myself that he wasn’t dead – his mouth was.

I waited for an ambulance and offered him pain relief but I have to admit I stood as far away from his breath as possible because I hadn’t yet eaten and I was vulnerable. I couldn’t’ be seen to retch in front of him. I make no exaggeration of this; I had to warn the crew when they arrived that it was not a pretty aroma to work near.

The next call was to a 57 year-old who was ‘unconscious’. I arrived to find a tall, elegant man in the hallway of a block of flats. He wasn’t my patient and he pointed to the floor, where a man sat with a lit cigarette in his hand, puffing away. I asked him to put it out and he had to be persuaded, while struggling to inhale the last few breaths of smoke, by the man who was his neighbour, who pulled it from his hand. It was like watching the sitcom Last of the summer wine.

The man had never been unconscious but his friend looked fed up as he tried to steady him on the floor. He was clearly very drunk and I was told he was a cancer patient but this current problem had nothing to do with his ailment. We’d been called because the neighbour couldn’t cope with him any more.

I tried to reason with the man on the floor and stood him up to see if he wanted to go back to his flat but he became aggressive and violent, swinging his fists at me and almost landing one on my face. I wasn’t about to be hit tonight, so I held him back against the wall and asked him to calm down, repeating over and over that I was there to help him and that nobody was going to force him to go to hospital if he didn’t want to. This had no effect and he remained irrational.

When the crew arrived, the attendant got as much abuse as I had and it fell to me again to try and communicate with him. He was an ex soldier, I was told, so I asked him about his regiment and career. This calmed him down and he became a nice person for a while.

We still had the problem of getting him to a place of safety because he was adamant that he was going to buy a bottle of brandy. He couldn’t walk without falling down, so that wasn’t going to happen and we couldn’t just leave him in the hall, so we spent a long hour persuading him to go to hospital. We almost had him convinced when he realised he couldn’t find his keys – then he exploded again and fought us off if we approached him or touched him.

The man was ill; he had been suffering blackouts and memory loss – he couldn’t remember how he’d got downstairs and why we were there and he eventually relented when his keys were found in his pocket. I chatted to him about his army days as we walked him out to the ambulance and he submitted to the care he obviously needed.

He was drunk and he was belligerent but sometimes you have to look past the obvious and consider other possibilities for a person’s behaviour. He wasn’t well and, alcohol or not, something was affecting his brain.

A call to a local hostel, renowned for its violent drug and alcohol abusing clients next and I was standing on the pavement with the police and a seriously angry man who had been assaulted. He had a head injury but refused to go to hospital or even to have me look at the large wound. Instead he wiped the blood with his hand and flicked it in my direction saying ‘F**k off! See, I’m alright, I’ll just clean it off’. I didn’t need any more convincing that he was a problem, so I cancelled the ambulance and told the police officers that they could have him. They cuffed him and he was loaded into the back of their van, shouting and swearing as he went. He was a class act.

No patient contact on the next one – two separate calls came in from Victoria station and it created confusion because two ambulances and two FRU’s, myself included, were despatched but we all congregated around the same point where one patient was vomiting and semi-conscious. The other patient was elsewhere and had just fallen over.

Later on I got sent to a block of flats in one of the less savoury estates for a 23 year-old woman who was having chest pains. Her family was on scene and I needed one of them to translate. She was clearly anxious and had been hyperventilating, giving her the chest tightness and light-headedness she thought was serious. This had been going on for hours apparently, so she definitely had issues worrying her.

I was told that when this happened before her GP prescribed Propanalol. This had me thinking because it’s not the drug of choice for anxiety (it’s a beta blocker) but I looked into it a bit more and learned that it can be given to reduce the physiological triggers for anxiety, thus reducing the possibility of panic attacks. She’d been told to take one ‘as and when’ she needed them but I think she probably needs to take them regularly for any effect if she’s that anxious.

A 39 year-old epileptic man who’d been seizure-free for some time had a fit in a hotel and I was on scene trying to hold him in a chair while he battled to get out of it. He was post ictal and attempting to walk out into the street. For his own protection, he had to be pinned down for a few minutes until he recovered. He was very strong and once again I nearly got myself knocked out trying to calm him. It’s almost impossible to speak to a confused mind.

Eventually, and coincidentally when the crew arrived, he settled and began to make sense of his surroundings and circumstances. He was walked out to the ambulance with no more fight left in him. I was out of breath.

All was quiet for a few hours after that and I got a break at the station. Then a call came in for a 22 year-old male who was injured as the result of a RTC. It was four in the morning and traffic was almost non-existent, so I contemplated the possible mechanism for this one.

I arrived on scene and the road was taped off; four police vehicles were there and a man was being held down on the ground as he screamed out in pain. I didn’t see anyone else injured but an update had informed me that there were two people involved.

The man on the ground was handcuffed and my raised eyebrows were met with ‘he was thrashing about with his arms’ from the police officer holding him. I still didn’t get it yet.

‘My leg’s f**ked – I heard it snap’, screamed the patient.

A crew arrived as I asked the police officer to hold the man’s neck still while I had a look at his leg. He was wearing socks over his trainers and I had to cut through them before moving onto his trousers and exposing his leg via three layers of clothing. I knew it was a bit chilly out but it wasn’t freezing.

He had an obvious open fracture of his femur; a serious and potentially life-threatening injury. He also had a fractured tibia (his other leg) which was found after we’d stabilised his long bone with traction. I administered morphine and my colleagues busied themselves with the business of reducing the fracture. One of my colleagues is a HEMS paramedic, so she was in very familiar territory. I haven’t dealt with a femoral fracture for years, so it was good to have her experience on board and that bloody Sager splint has always been a bane for me.

Another ambulance arrived to deal with the second patient – a man I hadn’t noticed because I was too busy with the screeching patient on the ground. He had a back injury but wasn’t in danger, so they took care of him.

After thirty minutes and a job well done by the three of us, even if I say so myself and on behalf of my colleagues, we were on our way to hospital with him.

The story of how these two came to a sticky stop is interesting. They were on a moped and had sped out of a junction when a police patrol had spotted them and given chase. There has been a recent spate of smash and grab robberies around here and the suspects were probably using a moped to get away, so the cops went after this pair on that suspicion – and the fact that their driving (and at that hour) was shoddy.

The moped driver (my patient) clipped a car and was thrown into a post, leg first, breaking it immediately (his leg, not the post). His mate came off but got up and ran into a taxi, presumably to make a getaway. Police officers piled into the taxi and dragged him out. He collapsed on the ground pretending he was unconscious and the cops tapped his face and shouted ‘stay with us’.

The only seriously injured person was the driver. He had worn socks over his trainers so that his sole print couldn’t be detected. One other item that I’d seen lying in the street next to him but couldn’t work out at the time, was a pair of pink marigolds. They were, of course, the finger-print covers.

Now, come on! If you are going to rob public places surely you’ll want as low a profile as possible? Why not don a pair of surgical gloves? Why use huge luminous Marigolds?

Not only were they a couple of prime idiots but one of them will now have to walk with a limp for the rest of his life if his leg doesn’t heal well. His x-ray certainly indicated some heavy-duty surgery in his immediate future and regardless of the possibility that both these young lads could have lost their lives, the cops, although relieved that it hadn’t come to that, were pretty chuffed that they’d probably (more than likely) caught the perpetrators of recent crimes.

The only plans that came together tonight were the one where we save the man’s leg and life and the one where the cops get the baddies. The plan to smash a shop window and grab whatever was around never came to fruition. Even the innocent moped suffered for the crime of greed.

Be safe.

Wednesday, 6 May 2009

Self abuse

Night shift: Nine calls; one conveyed, two assisted-only, one false alarm and the others by ambulance.

Stats: 2 Chest pain; 1 DOAB; 4 Etoh; 1 Drug o/d.

Back on nights - I’ve had a few stints of annual leave to help me avoid these long, busy dark shifts but now I have to face them again.

And so off to a 28 year-old man with chest pain – not likely to be cardiac but you never know. He was sitting behind the counter of an off-licence (where he works) and his colleagues were on scene to help me understand his problem because he didn’t speak much English. I was told he had a familial history of irregular heart beat; his father and grandfather had suffered from it – the latter had died as a result.

I was surrounded by booze and sweets as I examined him and noticed that he was quite pale. Otherwise his pulse felt regular and steady and his other signs were normal but the crew took him out to the ambulance by chair, as is required for chest pain. I was quite peckish for a Twix after being in there.

My DOAB was on the top deck and at the back of the bus (as usual), where he slumbered with a can of extra strength lager still in his hand – a dead giveaway for the driver who’d called it in as ‘unconscious’. He might have added ‘possibly drunk’ but he didn’t and my assumption that he was, based on years of dealing with such patients, proved correct after I’d asked Control not to bother sending an ambulance for this one until I’d checked it out.

I woke him up in a few seconds (I’ve become very good at it) and asked him to leave the bus after uttering the famous have-to-ask question ‘do you need an ambulance?’ He didn’t and he slurred his way through an unintelligible response to confirm it.

As he raised his heavy drunken head and body from the seat I noticed a large suitcase beside him. ‘Don’t forget to take your case’, I said. ‘You bring it down for me’, he replied. ‘No, you brought it up, so you can take it down’ I responded. This made him unhappy and no doubt a letter of complaint against me will wing its way to ambulance HQ in the next day or two, providing he remembers where he was, who I was, what happened and what year it happened in. Of course, he might just mail a can of lager in by mistake.

He staggered down the stairs with me behind him and his case fell apart at the bottom of the steps. The contents of his life fell out onto the floor – two further cans of special. The original, hand-held can was in his inside pocket, he’d placed it there gingerly when he was asked to leave. As he bent down to pick up the beer he said ‘aw, my two babies’ and the liquid from his opened can spilled out from inside his pocket, like it was bleeding – or urinating. Now he had a mad juggling routine going on; should he save his babies or his obviously fatally injured other kid (by another marriage)?

I helped him get his case back together and led him out into the London night. Now, I’m not one for kicking babies at all but I had to use my boot to help the cans back into their home. I didn’t want to touch them and it was easier than bending down with him and letting my guard go. Drunks can get very tetchy around their children.

The next drunk I encountered was leaning on a fence but I only knew he was my prospective patient because, of the two drunks to choose from in the same street, both of whom could have been the candidate for the call that simply stated ‘laying in street, appears drunk’, the other was on some steps and chatting into his mobile phone – real or imaginary, I couldn’t tell (I’ve never seen a street drunk on a mobile). So, I chose the fine fellow who was propping up the fence and stopped to ask if he needed any help. The crew was arriving too, so eventually the three of us stood around him asking him to go away before someone else panicked and called an ambulance for what might seem to be totally unnatural public behaviour (i.e. staggering, swaying, lying down and sleeping).

He refused and we all took that as a sign from above that he didn’t want to go to hospital. He was left where he stood and he re-propped himself for the night. He’s probably still there.

A cancellation half-way to a ‘man whose been strangled, police on scene’ meant that I wasn’t going to see the person who’d been brutally assaulted. To tell you the truth I couldn’t imagine it being an exciting adventure.

NPC for the 56 year-old Casino cook who suddenly developed chest pain at work. A crew was on scene and I didn’t do anything except carry their bag as they left with the patient strapped into the chair.

Two MOPS, a man and a woman, probably on their way to an exciting night out, called 999 when their evening (and path) were obstructed by the body of a man lying on the pavement. Well, they couldn’t just walk on by and leave him there, could they? This was Central London and such human obstacles are quite normal but it is entirely understandable that people should occasionally show concern. I figured they must be out-of-towners.

The man on the deck was in the recovery position, placed that way by the gentleman who was now waving at me to stop as I arrived on scene – on his face was etched a mixture of concern and resignation; he already knew what I was going to tell him.

As for the laterally-laid man, he could have put himself into the recovery position because he wasn’t unconscious and he sat up when asked to. I thanked the MOPS and they wandered off into the night and to a better form of entertainment than I was going to have.

‘I’ve been drinking’, the groggy, slow-eyed man said. He’d also been taking something much more potent and I suggested a cocktail of drugs may have been on the menu recently. He agreed and told me he’d taken Valium and Rohypnol; an unusual combination out of clubland but it accounted perfectly for his slow-motion behaviour and frequent relapses into compete brain stand-still while I was talking to him.

He was homeless and not at all aggressive – not that he could be with that lot on board. He told me he had Hep C and then warned me not to go into his bag, which had fallen onto the pavement just as he had. ‘There’s jar of pins in there without a lid’, he informed me, ‘please be careful’.

Now, I know I’m not the softest heart you’ll ever have read (or meet) but I felt some gratitude for having been warned not to stick my mittens into a container full of exposed used needles, so from that moment on I remained very nice to him. He was incapable of getting up and walking off, which is what he should have been doing, so the ambulance crew took him away and he got himself a warm bed for a few hours. I do hope he hadn't taken the 'Roofies' so that he could molest himself as he slept.

My next port of call was to a phone box not too far away from Leicester Square, where a 32 year-old man who should have known better was slumped on the floor with the phone still in his hand and the display flashing ‘999 emergency’. I took the phone from him and told the person at the other end who I was, then I hung up and asked him what was wrong.

‘I’ve had cocaine and ecstasy’, he said. One drug just isn’t enough for some people and now he was suffering from tremors, paranoia and cold sweats. He’d used the stuff before but this time he didn’t know the supplier and that’s always risky for a user; very often drugs like this are cut with other, less than exotic substances, like baking soda but sometimes more harmful adulterants are used.

I waited and waited for an ambulance but relented and took him to hospital myself in the car, something I’d rather not do with a druggy. He told me this was the first time he’d been ill as a result of his habit but when I got him into A&E I noticed a plaster mark and puncture on the back of his hand, where a needle or cannula had probably been. When I drew his attention to it, he told me that he'd had a heart attack after using cocaine recently. I didn't know whether this was true or not but it blew my 'he's normally fit and well' statement, which I'd just given in my handover, out of the water.

Young vomiting women are very common when the weather improves and the weekend is heralded by the mid-week (yes, I know, Friday used to be the weekend’s herald, then it was Thursday but now its Wednesday – soon we’ll be starting our next weekend before the current one is finished, getting drunk on a Sunday before sobering up for an hour and starting all over again).

So, a 25 year-old girl with no dignity left and very little clothing on, lay on the floor of a small, noisy club, throwing up the entire contents of her stomach (and a little more for good measure). The sick flowed like a little river down the incline of the floor, heading towards my boots but I’m wise to sneaky vomit-floods and none of it made contact with me. Instead, her hair and face got covered and now she epitomised the advert that has been aired over and over – you know, the one where the girl is getting ready for a night out but she is plastering her hair in sick. It’s good to know that these multi-million quid television ads are having an effect.

I waited for the crew to arrive and we scraped her up and poured her into a chair. Of course, as always, claims of drink spiking were thrown around by her friends but I think she’d just had fifteen too many...

...As had my Irish patient on the next call. Control phoned me to advise that there were no ambulances available for the 21 year-old male who’d fallen and sustained a head injury at a club. He was drunk and boisterous, so I was asked if I could go and check it out but if I didn’t want to, they’d understand. I frequently get sent into dark estates in the middle of gangland south London without any cautionary advice but for a young hard-drinking Irishman with a loud voice I was being offered the opportunity to wait for backup?

I trundled off and found him sitting with club security and a mate. They’d been waiting half an hour. The patient was noisy, drunk but friendly and there was no threat here at all, especially as I had three very large men watching over me. The worst I got out of this encounter was a cheeky remark from his friend when he saw my watch and said how cheap it looked. I told him I only wear this one at work because if I lose it I won’t care (and it has a little light so that I can see the time when it’s dark). I also considered asking him if he could possibly tell the difference between a £20 timepiece and a Rolex (that wasn’t knocked off) but he may have been a jeweller by trade, so I didn’t.

My patient had fallen backwards and cracked his head on the bar. Now he had a decent gash in the back of his scalp – nothing life-threatening but it would have to be closed up. I dressed it and waited a short time before the crew came and took him away. On the way out, he pulled my perfectly good dressing off his head. I don't know why I bother sometimes.

I went home after a false alarm for an ‘unconscious’ 25 year-old led me to a bar that was closing, with people spilling out onto the pavement. The woman who’d called came up to me and apologised. ‘I thought she was in trouble’, she said. Then she pointed out my ‘patient’. A tall girl was getting into a taxi with a man. I asked if she was okay and was told that she’d initially fallen down drunk but had been helped up and was now being taken home by a friend (at least I presume he knew her). The emergency was over before it had begun. I just wish someone had called us back and cancelled it.

Be safe.

Friday, 1 May 2009

Decapitated car

Day shift: Six calls; three conveyed and three by ambulance.

Stats: 1 RTC; 1 Renal problems; 3 Falls; 1 PV bleed.

An early morning RTC involving a car and a HGV that rudely awakened the driver and passenger by slamming into its rear end on a busy main road had traffic stopped completely for a while. Another FRU was arriving as I pulled up and the paramedic on board dealt with the passenger, a male who’d taken the brunt of it and now complained of chest and back pains. His wife, the driver, was on her mobile phone, crying and talking at the same time. She appeared unhurt and I asked her to go over to the pavement while we dealt with her other half.

A crew arrived and the police followed shortly afterwards, closing the road off properly, much to the disgust of rush-hour drivers heading our way. The result was a tail-back for about a mile.

Inside the car, the man continued to complain about his pain and the slightest movement made him cry out, so there was nothing else to do but wait for the LFB (London Fire Brigade) to cut the roof off so that we could get him out. He didn’t object because it was a hired car.

It took a while for the LFB to arrive but when they did all hands were on deck, so to speak. I sat in the back holding the man’s neck steady as a collar was placed and then I was given a hard hat for the incoming glass that would fly my way when the car’s structure was torn apart by the ‘jaws of life’. The patient had a blanket over him to protect his eyes as the loud crunching began.

It took ten minutes to get the roof off and then, with the help of a few firemen, we slid the man out of the vehicle on a board. All of this was precautionary but the car wouldn’t survive the damage. Insurance companies must hate us all.

An 87 year-old Irishman with MS and blood pressure problems was also suffering from urinary retention and I took him to hospital in the car, confident that he wouldn’t lose bladder control on the way. He was fine when we arrived but more than a little uncomfortable – he hadn’t passed urine for a long time apparently.

‘Would you mind if I adopted you’, asked the 71 year-old lady that I’d managed to get up three sets of escalators when I was told, again and again, that there was no ambulance to send for her. She’d fallen – dragged down by the weight of her suitcase – onto the escalator at the bottom of a tube station and had a minor head injury. At first she couldn’t stand up without becoming dizzy but she recovered well enough after a sit down and chat, so I took her up stage by stage with the help of the underground staff on scene. A chair was placed at each level so that she could sit down to rest until I finally got her to the car. The adoption papers are being filed as I write...hope my mum's okay with that.

Then a 30 year-old woman who had just completed her General Medical exam began to bleed PV. She was having a miscarriage and I think the stress of those exams had made her pregnancy come to a premature end. I gave her a large dressing to use as a makeshift pad while she struggled to come to terms with what had happened. Her baby was gone; she knew it and I knew it but she remained as calm as possible throughout.

A crew on another call stopped to help me with a patient I had been sitting with in the street for almost an hour. A fire crew had stopped to render aid when they came across the incident and they waited to help me if I needed it. I think they were bored.

There was no ambulance for my patient and they offered to take him to hospital. Initially Control wouldn’t allow them to do this because they were on another call but as they’d been flagged down by one of the firemen they were told they could take over and the original call was cancelled (and then given to me!).

The man had a head injury after falling in the road. He’d missed a step and gone flying, according to his carers. He had Parkinson’s and was very vociferous, swearing a lot and shouting (no connection to his afflication I must add) when it was unnecessary. I was told it was his nature. Lovely.

When I got on scene at a train station to help a 93 year-old woman I discovered that she was only 26, so I wondered if I was at the wrong call. She was sitting on the concourse floor and complained of leg pain. She then went on to explain, in great technical detail, what was wrong with her knee. She had a long history of knee injury and operations and she was very fluent in medical jargon. I thought she’d just learned it because of the journey she’d taken with it all but I found out that she was a radiographer. She'd fallen on it and now it was damaged again.

The crew took her away after I’d given her entonox and offered her something more powerful if she needed it. She didn’t and a quick transfer onto the trolley bed with a splint in place went without a hitch. She was too far gone on the gas to care.

Be safe.