Friday, 26 June 2009


Bar Italia, where the night can be calmed by a free cup of coffee and the friendly staff. We love them really. (free ad) :-) - taken by LottieCAM!

Day shift: Ten calls; two refused; one left at home; the others by ambulance.

Stats: 3 Chest pain; 3 eTOH; 1 Asleep; 1 Throat infection; 1 Drug o/d; 1 Stabbed.

A crazily busy weekend of nights and I didn’t meet a single crew that was entirely happy to be out and about on the frontline (a word that sums up more and more the work we do).

Charlotte continues her research into what we do and why on Earth we do it, so she was keeping me company for these shifts. We found a pizza place that perfectly matched the night requirements for eating on the go – quick, cheap and always open, with the best fresh made pizza I’ve had in ages. So we made that our haunt as we crashed and burned through several shifts of ridiculous calls and violent encounters.

A horrible estate first and a call to a 73 year-old man with chest pain, who really didn’t have anything wrong with him except a history of various old-age illnesses and a son (who wasn’t on the premises) who attacks ambulance crews. The police were on scene as we headed upstairs to the flat with the crew.

Meanwhile, down below in the little parking area, a 7 year-old kid guarded the vehicles for me and it cost me a quid not to lose my wheels – a fair deal I think. However, word must have got round that there was a soft-touch paramedic on scene and I forked out another two pounds for his brother (who is six) and mate, both of whom felt the need to reinforce the security around our vehicles. The boys were well mannered, if a little hyperactive and I saw no harm in helping them earn extra pocket money. A relative of the patient told me that they regularly looked out for traffic wardens when residents parked illegally. Entrepreneurs in the making.

A call, given as an epileptic fit turned out to be an alcoholic with withdrawal problems. The area is well known to us for harbouring East European drinkers and so I wasn’t a bit surprised to be windmilled to the man by one of his associates. I knew his face, so I must have treated him before but he denied ever having been in hospital before. There was nothing wrong with him except a need for alcohol in his blood and when he got to A&E I have no doubt that he’d source something for his appetite.

A lot of chest pain calls were coming in and I seemed to be copping them one by one. Everything seemed to be Red3 on my screen. My next patient, a 50 year-old woman with a history of angina and anaemia, was genuine and had been waiting a long time for an ambulance – ironic really. We spent about 20 minutes chatting to her and I kept an eye on her condition, which had improved since she’d taken her own GTN. Her worried husband explained that she ‘wasn’t the complaining type’ and I felt annoyed on her behalf because she is a candidate for immediate service from her NHS, unlike our last patient, for example.

The next chest pain was typical of the nonsense we are struggling to cope with when it is very busy. The man actually waved at us from his front door before plonking himself back onto his sofa and throwing his hands up to his head in dramatic fashion, most likely to show us that his condition was life-threatening and he could die at any moment. He’d been seen by his GP earlier – he had a chest infection.

Not only were these calls blindingly stupid in terms of their response categories but they tended to be nowhere near where I actually work. I was being thrown all over London in a radius that seemed limitless to the system. Travelling 5 miles on blue lights isn’t unusual for a lot of services, I know and I appreciate that but others would agree that the more distance you have to cover like that, especially in heavy traffic, the more likely it is that you can make a mistake in judgment with your driving, It is extremely tiring mentally. The possibility of making it to the patient within our Government obsessed target times is also smaller, so there seems little point. On the calls I received in between the ones I am writing about, I was either cancelled half way to the scene or another ambulance showed up on my nose or my tail. Statistically, we are doing at least 30% more in terms of call volume per shift – you just don’t see it because I don’t write about it.

A Red1, cardiac arrest call in Soho late at night had me frowning all the way there because I knew the street and the likelihood of a young woman actually being in cardiac arrest outside so many clubs and pubs was lower than me going to Mars next year. She had fallen down drunk and she refused help when I got to her, while pawing at Charlotte’s face and making good eye contact (so I think she was in there). The crew arrived fully prepared to shock and go until they too realised there was no emergency here.

Another Red1 soon followed with ‘life status questionable’ on the ticket. Yeah, yeah, right. 'Lying on floor outside house', it stated.

It took a while to get to this potentially dead person because it was miles away of course but I found him and he was exactly as I’d have described him on the tin, if you’d bothered to ask me. Drunk and asleep on the pavement.

People just love calling ambulances when there is a human lump lying near their pricey properties. They don’t have the common sense, or balls, to go and see if the person they are dragging us out and away from genuine cases for is actually breathing. You don’t have to touch the person, you just have to go and look! Shout at them, wake them up and tell them to go away because they are bringing down the value of your home. They will understand, I’m sure.

The drunken Scouser smiled at me and was obnoxious, as usual but I walked up to him and had a quiet word. There is something I do that I will never divulge; it’s not offensive and it’s not illegal but I have a special quiet word with certain people and I get an instant result – always. He stood up, apologised and staggered away – influenced by the magic of certain words strung in a certain way.

A large 8-year-old boy was dragged across the bed by his equally large and very doting mum as she presented him to me for examination after her 999 call for a throat infection. Yes, he had a high temperature and yes, they were very nice people and accepted the fact that all he needed was bed rest, fluids and paracetamol but why couldn’t they figure this out for themselves? She had other kids, so she was an experienced parent and the older son got it straight away. They wanted reassurance and I accept that but really, honestly, what is happening to us all?

In the early hours of the morning, a drug addict decided to top himself with 200 valium (where’d he get them from?), heroin and booze...or so the caller had stated. So, the police were arranged and we sped south for a LOT of miles (thus ensuring that he had little or no chance of survival had he actually been so stupid) out of area to get to him. We arrived in a dark street with the police pulling up ahead of us. The crew turned up a few seconds later and we tried to gain access to the grubby, paint-shy front door without initial success.

Through an open window, high above the basement flat below, I could see a pair of feet sticking up from a sofa. I shone my torch inside the room and saw no movement. The feet were kind of black and this was a white-skinned man, so I thought we might be looking at a long dead body. There were certainly a few flies around, so my colleague and I climbed along the precarious window ledge and into the room. He landed safe and dry and I landed straight in the cat’s water bowl (at least I hope it was the water bowl), soaking my trousers leg to the back of my knee.

The Spider-man super-hero impression was lost on our captive audience however, because they had all just sauntered in through the front door after it had been opened by the further-ahead-than-me colleague, who'd gone through the room and unlocked it. Even Lottie thought it was a bizarrely risky and badly-timed option. She just doesn’t understand – we do it all for the accolade; a broken neck is nothing compared to a shiny medal.

Inside was a sleeping druggie with very dirty feet and the worst fungal infection of the toes I’ve seen for some time; rancid is the only word I could use to describe it and there you go, I have. He was a nice enough person, in terms of not abusing us, shouting at us, spitting, vomiting, peeing or punching, so that was good but he had taken a lot of something and we suspected it was heroin, so he was jabbed with narcan for good measure. His sleepy-eyed reaction and sloth-like movement justified the precaution – as did the paraphernalia covering his floor, the full-to-the-brim sharps bin and the numerous fresh injection points and tracks on his arms.

But he was a rubbish suicidal person because he knew nothing of 200 Valium and even less about the 999 call. He thought it might have been a woman he knew that had done it to cause trouble. I agreed that it might have been ‘whatsherface’ and he (for whatever reason) took me seriously.

‘Oh, do you know her?’

‘Errr, yep, I do...’ I lied.

I also suggested that the cat – a little skinny black thing that wandered in to investigate who the hell had upset it’s drinking bowl and then went to attack a dried up, age-old slice of pizza that sat on a plate on the floor as the man leaned down to snatch it up and munch on it himself (the pizza, not the cat) – might own a mobile phone and had made the call for help. He agreed with this in principle and giggled at the thought but his mushed brain had no concept of irony or sarcasm and many who know me feel that this is all I have left with which to play this silly game. Drug addicts and alcoholics will actually take me seriously on many things, including UFO appearances and the scandal of a healthy lifestyle.

The man recovered enough sense to be left at home. He refused to go to hospital, despite several warnings about the risk he was taking. He had capacity to make a decision and the cops couldn’t agree more because they were getting bored now. I’d given them something interesting to do earlier when I suggested there might be a dead body hidden somewhere – the large number of flies alluded to the possibility. I was half-joking but they felt obliged to force in the door to another room in the flat just to be on the safe side. They had, to be fair, given the drug addict plenty of opportunity to tell them what was behind the door and he had simply vanished into his own cranium with nothingness each time. They had no option and there was no need to stand and stare at it any more.

There was no corpse on the premises. The cat would have eaten it anyway.

A stabbing in Soho led us to a young man who’d been knifed in the shoulder and back. He was still standing and talking when we got there, so I wasn’t too concerned but penetrating wounds to the back are potentially life-threatening, so an ambulance quickly took him to hospital. His mate had been bottled and there were still fragments of glass in his hair and around his ear. The bump on his skull was small but he’d been knocked out, so he also went to hospital. I was left with blood on my hands and a reason to say I was worth calling out.

So, to end the shift I got a reminder that those ‘sexy’ stabbing calls were rare and not my business for the most part. I was gifted with a 21 year-old crying, drunken girl who collapsed outside a club after drinking way too much and reasoning, by proxy, that she couldn’t possibly be drunk and that she’d been spiked or something.

What concerned me about this call was the number of guys that were hanging around. A few of them were hugging, holding and pawing at her, telling me that they knew her. One of them had the cheek to tell me he was her boyfriend but she denied this, crying out ‘tell him to leave me alone!’ when she got enough breath in her lungs. Drunk or not, she was vulnerable and prey to these young animals who just want an easy lay after a night out searching for the weakest of the pack. Her tall, loud friend was with her and she eventually stepped in to block those men as they tried to drag her away God knows where for ‘treatment’. I asked for police assistance but they wouldn’t be arriving – everyone was busy tonight and this wasn’t an emergency really.

The crew got her into the ambulance and I helped them with the protestations of the patient’s friend and the patient herself until all calmed down. It turns out this young woman has cancer and is struggling with that fact. She got blind drunk to find an escape and I couldn’t help loaning my heart to her as the pain swept her inebriated, tearful, mascara streaked face. ‘Please don’t judge me’, she sobbed and shame throttled the expression I must have had on my face until I reassured her that nobody on board was doing that.

Outside, the small, weasel person who told me he was the girl’s boyfriend, persistently badgered us, opened the back door and knocked again and again until I’d had enough and I flew out at him and threatened him with the police if he didn’t back off and leave us to treat our patient, who was now screaming ‘go away!’ as another voice, that of a very drunken 50 year-old woman, drifted in from the front window of the vehicle at the same time as weasel-boy’s annoyances. The woman had introduced herself to Lottie. She held a bottle of wine in her hand and again, I think Charlotte pulled – the slurring lady insisted on tracking her for a bit and reminding her of how old she was. She said 48 but I am saying 50. Drink will do that.

Michael Jackson died and Trafalgar Square became a shrine for him. The walls of the National Gallery were covered in goodbye graffiti and candles burned at the gates. The connection eludes me, quite frankly. Was he known for his great paintings?

I want to make it quite clear that my Control colleagues are not the enemy of frontline 'grunts' like me - they too are under extreme pressure and I feel very sorry for them as they try to bring order to the chaos that is London's demand on its emergency healthcare system. None of us are paid enough for the mental stress it causes and this post, and the ones to follow, are written in tribute to my colleagues out there and to all Control staff, few of whom have a forum to air their views on. I hope my writing (including the cutting sarcasm) does them justice.

Be safe.


Fiz said...

I haemorrhaged this weekend after a four hour long attack of the runs. Worked out it was fresh blood, therefore from a pile and it stopped once the attacks did. i reason if I ws bleeding inside it would look a different colour and it would continue. So I did not ring an ambulance or pester my GP. Next time I have to see him. I will mention it, just to be sure.

MarkUK said...

Stuart, you wrote:

The drunken Scouser smiled at me and was obnoxious, as usual but I walked up to him and had a quiet word. There is something I do that I will never divulge; it’s not offensive and it’s not illegal but I have a special quiet word with certain people and I get an instant result – always. He stood up, apologised and staggered away – influenced by the magic of certain words strung in a certain way.

C'mon guy, give us the lowdown (even if by individual email). Lots of us could use your "drunk whispering" technique!

Little Miss Ileostomy said...

We used to cross the road to avoid the sleazy men outside Bar Italia!

There's a "shrine" to MJ at the o2 as well. I don't understand it at all, how can you get upset about someone you don't know.

There's some very selfish people in London, seems like they all want to call 999. I got the bus to A&E with a sub-acute bowel obstruction , as to me ambulances are for life threatening emergencies.

Hope you get a break soon. You sound like you need one.

Xf said...


:-) Some mysteries are better left that way. said...

I have to confess to spitting nails after reading this blog.

After service in the RAF, I found myself on front-line ambulances in Surrey. However, any similarity between the service 25 years ago, and the modern service in relation to the conduct of patients, is worlds apart, though I hate to say this, in my 'day' we still had the odd moron to deal with.

On one occasion, some comedian managed to fall of his horse. Ample opportunity you might think to break bones, or badly damage important giblets. Not so this particular individual. Having declined help from his companions he found his way home, walked up the stairs and lay on the bed while his wife called for an ambulance. On arrival, there then followed much gnashing of teeth, and less than polite comments.

Conversely, we were regularly exposed to the type of call where we would be met at the door with the greeting, "sorry to trouble you." and "he/she has been unwell for x hours, and we could'nt get hold of the doctor". This from a generation who thought that unless an extremity (arm, leg or perhaps head), was held onto the body by a sliver of flesh, then it only warrented a band-aid, and not a blue light ambulance.

I despair at the overt hostility met by our modern day guardians (emergency services), compared to the palpable relief shown just a generation or so ago.

Much gnashing of teeth, and to all, I offer my profound respect.

Xf said...


Thanks Tom. Nice to hear from a veteran colleague. I think you guys need to take the credit and respect for working with less to hand back then...but yes, things have changed, haven't they? Well, people have changed.

Katie said...

I work in a ward attached to the ED in Leeds.

The abuse of services is wide spread, apart from the usual drunks and NFA's looking for a cosy bed for the night, we get people self discharging after a couple of hours after being 'rushed in' because they are feeling better and cant be bothered to wait to see a doctor.

It also annoys me when people ask for transport home (well I did get an ambulance here!) even when they have the means to make their own way home.

Its heart breaking when you have to tell a 90 year old wheelchair bound old lady that they will have to wait hours for a transport ambulance because the service is so over stretched with people who can get a bus or walk insisting they get an ambulance home.

I cant imagine what it is like out on the front line on the streets. Hats off to you.

Hugh said...

this on the BBC website, re the current weather "emergency" - luckily up here in Glasgow it isn't relevant to us - the weather emergency that is

"The London Ambulance Service urged people to only call for an ambulance in a genuine emergency."

WTF - isn't that what supposed to happen all the other 364 days of the year too

Xf said...


LOL! Absolutely my friend but our spineless upper echelons are too scared to keep pressing that point all year round. They only ever do it when they see a good excuse that cannot be argued by the great general public. AND half of them would be out of a job if we hit too many 'quiet' periods.