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.


Uncle J said...

I thought that wearing "socks over shoes" was an ob-sole-te idea?

Panda Boy said...

Uncle J, I reckon it should be an ob-sole-te idea, because this irra-shoe-nal pair were not very socks-essful.