Friday, 31 July 2009


Trafalgar Square attracts all kinds of people! (Lottiecam)

Night shift: Nine calls; one false alarm, one treated on scene, one declined and the rest by ambulance.

Stats: 1 Faint; 1 Hyperventilation; 1 Cut throat; 2 eTOH; 1 Chest pain; 1 Coughing blood.

A 65 year-old Northern Irish woman fainted in a restaurant as her family looked on but was recovering well when I arrived. This is a common occurrence; the stomach requires more blood when a large meal has been consumed, so there tends to be a drop in blood pressure in some people – this causes light-headedness or fainting.

The patient was a type II diabetic but her BM was normal. She was taken to hospital for further checks just in case.

The false alarm was for a 20 year-old Chinese man who fell asleep (drunk) in Leicester Square’s park, prompting a Red1 ‘cardiac arrest’ call for some reason (well, the usual reason – nobody bothered to check if he was breathing). I sped to scene as if it could be genuine (you never know) but it wasn’t. I arrived to find a stressed out park security man puffing his way through an explanation that the man on the grass ‘was not responding to anything’. Well, he responded to me immediately and the bemused and embarrassed tourists around him (who had also thought he was dead) slunk off to a safe distance.

‘Do you need an ambulance?’ I asked the sluggish little man.

‘Yes I do’, he slurred.


‘Because I can’t move. I can’t stand up.’

You also can’t tell the truth, I thought. It crossed my mind that he might recognise it if he crouched and it ran in like a rabid dog and bit him on the arse but luckily that wasn’t necessary. As the sirens of two approaching ambulances (yep, two – ‘cos he’s dead remember) reached my ears, he stood up (not bad for someone who is paralysed) and walked off to find the toilet. And just to prove that he was more sober than drunk, he walked into the Ladies’ loo, corrected himself, u-turned and found the Gents. I remained in place, arms folded, as if I’d been stood up on a date. ‘Tsk!’ said I. ‘Tsk’ said the embarrassed tourists, some of whom were also lying on the grass but weren’t dead.

I overheard a funny little exchange on the radio after this job. A crew requested police to scene for a call they were running on; the call descriptor had stated ‘violent’ and so the dispatcher obliged and said the police would be sent. A few minutes later and I heard this...

Despatch: ‘Oh, sorry, police aren’t needed on this call. It actually states that he has diarrhoea. And that it is violent. He has violent diarrhoea. Sorry!’

Who the hell describes their runny number two’s as violent? Hilarious.

A stupid 21 year-old betrayed his youth and masculinity by refusing to stand up or walk properly because he was panicky. The call had been given as DIB but it was just another hyperventilating person who wouldn’t listen to the advice he was being given about breathing slowly. His work colleagues were around and so he continued to parody the dying swan for their benefit and although I understand the struggle of a first-time panic attack, his performance was not in tune with his condition at all.

I sat and chatted to a very good friend of mine who was leading a training crew. They sat in the back with the man until he pulled himself together and we jawed about life and the pursuit of happiness. As you do.

The serious call of the night was next up and I got lost in the traffic and roadworks (including several blocked off roads and diversions). It was for a 22 year-old woman who’d ‘cut her throat on glass’. These calls tend be something or nothing, so I went as if it was something, to be safe. I should have been there two minutes earlier than I actually was and it’s frustrating that the need for new water pipes is a potential for loss of life as a result of emergency vehicle delays. A crew arrived on scene before me and by the time I pulled up, they were bringing the girl upstairs from a club.

She had fallen onto a wine glass which had shattered, slicing deep into her neck and severing several main veins. Blood was gushing from her throat and it took enormous, persistent pressure to keep it under control. I went through four or five large, thick dressings trying to stem it but the wound was so serious that she began to slip away in front of us.

As soon as fluids were put up and everyone knew their place, we rushed to Resus with her. Her blood pressure had started to fall and she was perilously close to death. Blood stained every part of her clothing, even through to her underwear and pools of it gathered on her chest.

In Resus, she was given blood infusions and the frantic efforts to stop the bleeding continued. They were still ongoing when I left. I wouldn’t know until the next night what had become of this young woman.

A drunken 35 year-old woman demanded to know where her shoes were as the crew took her aboard the good ship NHS. At first she’d been uncooperative but had relented and allowed herself to be ‘treated’ for her excess. She’s probably a mum with two proud kids somewhere.

This call was followed another of the same ilk; a 40 year-old woman lay on the pavement, surrounded by police and PCSO’s... and a man she just met tonight, declaring that she was ‘hypo’. At first I believed her and checked her BM but it was normal at 5.7. ‘That’s low for me’, she said. ‘I’m not diabetic, I’m hypoglycaemic’, she then informs me, as if that’s a diagnosis of anything.

I decided she was drunk and being silly, so I left it to the ‘booze bus’ crew, who’d just arrived, to help her make her mind up. She didn’t like being told that she was a grown up, so she stormed off with her new boyfriend and took a taxi home (I guess).

Burping associated with chest pain and/or shortness of breath may be indicative of a heart attack. Unfortunately, there appears to be little material out there to confirm this but there are many, many personal reports. In fact, we are taught that burping is a significant sign and my next patient, a 54 year-old man who told me that he’d started burping ‘out of the blue’ after experiencing bouts of SOB for the past 24 hours and who now had chest pain, was a classic example.

Following the rule of ‘it’s only gas’ would have been potentially fatal for him but luckily myself and the crew that attended with me are switched on about this sign and his ECG confirmed an ongoing anterior MI. His heart attack was progressing so we quickly took him to hospital and straight to the Cardiac Cath Lab, where he got immediate life-saving treatment. He’d live to walk his dog again.

At a hostel in north London, a 34 year-old man walked down stairs and out to the ambulance, passing me and the crew as we made our way up to him after a call for ‘coughing up blood’. The alcoholic was even carrying a glass of beer and began sipping at it as he sat in the chair awaiting treatment. I absolutely hate the way people like this, who have ruined their lives through excess and stupidity, make us look like professional servants – they pay no taxes and generally give nothing back to society. They cost us dearly and often abuse their rights and privileges. Only those that have returned to society after having made a mistake with their lives get any respect from me because we can all end up where they were but those who choose that path and stay on it, while they get pampered and provided for, are nonsense to us all. This is your opportunity to tell me how bad that reasoning is and how we should all be glad to chip in to help them, even when they drink booze in the back of an ambulance, vomit and spit on us for the love of it.

The drink was taken away and poured out into the gutter. He wasn’t coughing up blood, he was just coughing.

An ashamed 21 year-old, caught drunk in a club and who was now too out of it to keep her eyes open, lay on a sofa as her boyfriend explained that she was ‘always like this when drinking’. The police arrived because a call had been made to them about drug use (she’d taken something with her booze) and she suddenly woke up and became semi-sensible. The cops weren’t interested and they left soon after, so I walked her to the ambulance when the crew arrived as she held on to my arm and told me how bad she felt. ‘I’m so, sorry. I’m so ashamed of myself’, she repeated.

Her boyfriend chipped in several more times about her state (for my benefit) and she showed him how much she loved him. ‘F**k off, George!’ she spat. How could such a nasty phrase come out of such a pretty mouth?

Be safe.

Tuesday, 28 July 2009

Young, gay and dead

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

Stats: 1 Cardiac arrest; 1 Abdo pain; 1 Back pain; 1 Head injury; 1 EP Fit.

First call of the day and it’s for a 29 year-old man who is lying on the floor of his male partner’s flat. He was found like this a few minutes ago – he’s in cardiac arrest as the result of alcohol and drugs (GHB and Crystal Meths). For some in the gay community this is a lifestyle and it’s simply not worth it.

My MRU colleague is on scene with me and we begin resuscitative efforts; the patient is still warm and pink but he’s a fit, young man, so there’s no reason to believe this is an indication of potential for recovery. His jaw is almost locked and it takes a lot of strength for me to get a Laryngeal Mask Airway in there. Intubation is not an option – it’s been tried by the MRU medic and it’s failed because of the stiff jaw.

A crew arrives after five or so minutes and we continue with CPR, drugs and no shocks – he’s been asystolic from the start and there is little hope of that changing, so we do what we can and look at the bleakest future for our attempt.

We take him to hospital, continuing his care all the way but they call it after a further ten minutes in Resus. So, before breakfast, I watched another young life disappear for no good reason; it’s depressing and makes me wonder what kind of day this is shaping up to be.

Abdo pain and groin pain next. A 43 year-old man, working as a labourer at a building site has collapsed and there is a protrusion in his lower abdomen. He may have a hernia.

The pain is only relieved with morphine – he refuses entonox and I find this to be quite common in people with abdo pain – just sucking on the mouthpiece causes further discomfort, so they tend to abandon it. I take him in the car because he is walking and talking and there isn’t an ambulance handy at the moment.

A 52 year-old woman is complaining of lumbar back pain at work. She walks to the car with me and tries entonox en route as her friend sits in the back with her. After a minute of travelling, she complains even more loudly about her pain and tells me that the entonox is ‘no use at all’, so I stop and give her IV morphine in the street. As I pack up ready to leave, a street sweeper happens by and delicately removes my debris (packaging and syringes) for me. Then we continue to A&E, where my patient’s condition continues to aggravate her despite the drug. She waits a long time before being booked in and clings to her friend as the pain beats her down relentlessly.

My MRU colleague was already on scene with a 68 year-old female who’d fallen down steps and banged her head. She had minor head and facial injuries; nothing life-threatening but enough to warrant a check up at hospital, so I obliged with transport and continued care. Her friend was with her – they were out on a jolly in London and I helped to create friction by remarking that she had spoiled it for everyone. It was all taken in good humour. Thankfully, I don’t come across too many dour patients and when I do, I don’t bother with quips to lighten the situation. I won’t waste energy.

Finally, an epileptic patient who had a 5 minute fit was recovering and post ictal when I arrived. She, like most of my patients during the day, was at work when she collapsed. She was very confused and had a bruised cheek for her troubles.

A crew arrived after I’d managed to get no sense out of her during my ten minute chat and by the time she was walked to the ambulance her memory was returning.

I start my nights soon... four of them to contend with. I apologise in advance if my posts become a little depressed as they progress.

Be safe.

Monday, 27 July 2009

Funny things can happen

Day shift: Four calls; one false alarm; one by car and two by ambulance.

Stats: 2 Abdo pain; 1 Unwell.

Off to a train station, with an ambulance coming up behind me (rendering me pointless) and I went with the crew to a collapsed 25 year-old female suffering from abdo pain. She has Crohns disease, so her pain is genuine enough. She has a slightly irregular ECG, so needs to have that looked at. But she also has a nasty bruise on her arm, given to her by an ex-boyfriend (nice). She tells us she has found someone who cares for her now and that he is gentle and kind. This is good because she is a nice young woman and doesn’t need a bully in her life. The story is made all the more relevant when she reveals that her new boyfriend is Scottish. Of course he is :-)

A 65 year-old woman took the bus from Swindon and arrived in London with her husband, only to step off and collapse feeling very unwell. She was as pale as a sheet when I got to her and she told me that she felt nauseous. She has no medical history and usually travels well, so when the crew arrived she was taken to hospital.

On the way to this call I travelled the shortest route, down the Mall and around Buckingham Palace. Unfortunately my timing was rubbish and they were changing the guard, with all the pomp and ceremony that goes with that, for the benefit of the tourists. My first hint that I wasn’t welcome with my fast yellow car, blue lights and sirens, was the annoyed looking police officer who was frantically re-directing me to avoid the horses that were heading my way. Oops!

Calls for ‘collapsed, trapped behind locked doors’ have given me corpses, genuine illnesses and trauma... and a few laughs. This one, near my station, for a 35 year-old female whose friend had been trying to contact her all morning after she’d said she felt ‘depressed’, descended into farce. The police were on scene and the woman’s friend was telling them how she was an alcoholic and could be so dead-to-the-world asleep that she wouldn’t hear the door being hammered. Or she could have done something to herself because of the conversation she'd had earlier with her. The cops were using their sticks to beat the living daylights out of her door before going round to the windows and trying the same. To sleep through that you’d have to be dead or deaf. I stood there wondering which one I’d be dealing with.

After a while of debating what to do and getting nothing from within, the police decided to break the door down. Just as the officer’s boot raised for the heroic one-thump ‘no key required’ access to the flat, a shrill voice cried out ‘What the hell’s going on?’

The tenant had returned from shopping (or drinking, who knows?) and she wasn’t pleased. She was visibly shocked that we were outside her door. She didn’t know whether she was going to be arrested or defibrillated. Ahhh, funny moments.

Finally, a 38 year-old woman with acute severe abdominal pain rolled around on the floor of her workplace Occupational Health Department. She gripped my arm and hugged me to the floor with her as her agony increased. She had real pain and needed morphine for it.

No ambulance was available so I resolved not to let her lie there like that but to deal with her pain and get her to hospital in the car – I know I’ll be frowned upon for it but duty of care means just that.

I gave the lady a decent dose of Morphine and by the time she was wheeled out to the car (they had wheelchairs and doctors in there but no analgesia) and placed into the back seat, she was positively grinning away to herself. She had gone to the land of Lah Lah, where at least the pain wouldn’t follow and I could manage her safely.

‘Are you okay?’ I asked before we set off. I needed to ensure she was conscious and alert, otherwise I’d give her the great antidote Narcan and she’d be back to her painful self.

‘Oh, yes’, she beamed, not caring a jot for anything but her current euphoric state.

When I’d been wheeling her out of the building, the lift had arrived and several young women were asked to leave it so that I could get in. The security guy was with me and he was going to show me out. But the lift doors had a mind of their own and they closed as the security man went in. I could see him frantically pushing at the buttons to stop the thing from leaving me stranded with the very people we had already emptied out of it. He failed and the lift went down. My patient and I stood there like idiots, smiling at the women who’d also been adopted for this floor unnecessarily (of course my patient was smiling at anything and anyone).

When the lift arrived again, I went down but found myself at the ground floor with no security man. He’d gone back upstairs to find me! I waited with my grinning patient until he finally appeared again (in the same lift) and showed me out.

When my job becomes a comedy of little errors, I don’t mind. My day is somehow brightened up by the humanness of it and I can go home content, which is all I want really.

Be safe.

Thursday, 23 July 2009

Naughty footwear

Day shift: Six calls; one cancelled on scene; one treated on scene; three by car and one by ambulance.

Stats: 1 Unwell person; 2 Abdo pain; 1 ? Swine flu; 1 Foot injury.

A 47 year-old vomiting woman with a headache and abdo pain worried me a bit when she called after presenting with sudden onset symptoms after a few days trying to beat back her head pain. I’ve seen SAH develop like this, especially in females of her age, so I wasn’t about to rule out anything significant immediately. She had no past medical history and was normally well. She may have had a simple viral infection or she may be in trouble, so as soon as she got to hospital they took her to Resus but I saw her later on in a cubicle and she seemed over the worst. The morphine I’d given her for the pain and the metoclopramide to stop her being sick seemed to have done the trick. I hope she’s fine now.

A call from a 33 year-old woman who had ‘menstrual dizziness’ seemed nonsense to me but I trundled over to where she worked and found her to be well enough to travel in the car (of course she was). The Portuguese woman held her head, moaned to herself and kept up a long telephone conversation at the same time as I drove her to hospital. She could have taken a cab or walked there – she had waited quite a while with a CRU paramedic tending to her before I arrived. I was only assigned because it wasn’t deemed serious enough for an immediate ambulance. That at least was accurate.

Then, miracle of miracles, she seemed right as rain when she arrived in A&E.

Abdo pain can cause a lot of discomfort; sometimes so much so that a person loses consciousness, depending on upbringing, DNA profile and pain threshold I guess. Of course, there are physical reasons for passing out but most of the abdo pain calls we attend are not serious at all and require no further treatment than obs and time to recover. So, the 23 year-old woman who called an ambulance (or had it called for her) from work and was now laying on the office floor ‘fainting’ apparently, was ‘tagged and bagged’ with normal obs and no hint of a life-threatening illness as she went to hospital with me in the car.

My first possible Swine Flu case next and it happened to be a Traffic Warden. He was on duty and had probably ticketed many victims before folding up with back fact he was ‘aching all over’. His supervisors were with him and they’d insisted on a 999 call, even though this guy was fit looking and had no previous history of illness. He wouldn’t even stand up for me when I got there; preferring instead to keep the drama going while being watched by his superiors. I know this game well, I’m afraid – you have to be really ill before you can get a day off work, so even if you are a bit under the weather, or perhaps taking on a few symptoms of Flu, it is important that you act out the agony of a recently shot soldier in order to get the necessary nods of approval as you are wheeled off in an emergency vehicle.

The agony didn’t stop him getting into my car, mask firmly stuck on his viral face, and seemingly improving when he got to hospital. The nurses took one look at his uniform and their eyes rolled to heaven. He may well have contracted Piggy Flu but he should have gone home or been taken in by car – they could have ‘impounded’ a naughty motorist’s vehicle, you know, one that was parked deviously outside a shop on a single yellow line, then transported their friend and colleague to A&E reception, where all the masks are worn with pride.

A call that was cancelled for me as I approached the scene made me smile a little. A 30 year-old female who’d complained of neck pain and had spent some time with a CRU before I turned up (and went to the wrong entrance), walked herself onto the back of the ambulance before the crew had even got a chance to pull on the handbrake. Priceless.

There is a particular type of shoe worn by children that is a potentially serious hazard for their feet and I have to warn you about them here and now. My last call, to a 5 year-old girl whose foot had become caught in an escalator at an underground station, rang a bell because I have been called to several such incidents over the past two years, only in summer, where children’s feet have been caught, pulled in and mangled by the teeth of the steps as they close off. The problem isn’t the escalator, or the children...or their parents – it’s the shoe they are wearing. It’s always the same type of footwear; those plastic sandal style things with holes in them (I believe the holes are for little colourful bits to be stuck in).

This little girl had a minor graze on her foot but her shoe was torn apart and had been dragged right inside the gnashing mechanism of the step as it slid down inside itself. Her foot would have been ripped apart too, if it wasn’t for the quick-thinking of her mum and a lot of luck. The last patient I dealt with had severely damaged toes as a result of this kind of accident.

The shoe is made of a material that gets pulled easily by anything touching it – the plastic seems to have an easy-to-grip surface, so the metal teeth of the escalator only need to make light contact with the toe area and the whole shoe will be pulled in, foot included.

Luckily, the girl was fine. ‘I don’t need to go!’ she said as I arrived on scene in the little control room. She and her mum were in good spirits about it but I asked mum to write to the manufacturer and point out the problem. A warning should be sent out; otherwise a child is going to lose his or her foot.

I laughed and chatted with this cheeky little Irish girl as her mum reassured her and I dressed the wound. She didn’t need to go to hospital and I didn’t want to upset her more, so she was left with mum to go shopping – for new shoes. Any excuse.

Be safe.

Wednesday, 22 July 2009

The first aid conundrum

After looking at a few of the responses I've had after remarking on the weakness of qualified first aiders in their capacity to do anything of any value, I've decided to run the debate as a post, instead of responding to comments.

You may or may not know (or have any interest in it) but I've been teaching qualified first aiders for more than fifteen years and run a fairly successful little company, training people all over the UK. I consider myself an expert on the subject and fully understand the legal capacity in which workplace first aiders are supposed to operate.

Unfortunately, a lot employers dont give a toss about this and only train their employees because they have to. They dont care that the training they receive may be inadequate, amateur or dangerous and they dont care whether those chosen to do the training actually make any difference to the work environment. Of course, many other employers dont even bother with any training because the Health & Safety Executive (HSE), which is the legal governing body in this country, has no teeth and very little time or manpower to seek out and punish them. You have a much, much higher chance of getting caught without a TV licence than without a properly trained person who can potentially save the life of a colleague.

Ive been teaching to a high standard all of my career and simply wont drop them; this has cost me a few contracts, I can tell you. Some of the biggest companies out there are so hell bent on not allowing their employees to have the responsibility and power that goes with their qualification, that they obstruct any attempt to teach the rule of law. This goes on in some schools too - the first aiders are frequently over-ruled by their superiors and one school in particular just would not have me telling them that storing prescription-only medicines on site when the children weren't there was potentially illegal (look at the medicines act) - it seems some people just don't want the facts.

My company teaches in around 100 schools a year. The market is dominated by the voluntray services, particularly The Red Cross and the St. Johns Ambulance (SJA) and I've come across some incredible pieces of advice given to those in charge of our little ones; 'dont put a plaster on a cut', for example - almost as if that is illegal. It's not and never has been. There never, ever was a rule against it. Also, the 'don't take a splinter out of a child's finger' (or any part of them presumably) because that's an assualt, based on the premise that it is an invasive procedure! Think about it, these people (teachers and school staff) are in loco parentis; they can do whatever a reasonable parent might do and I'm pretty damned sure a reasonable parent would remove a splinter and not bother calling 999 or taking the child to A&E!

I'm not having a dig at one organisation or another and I'm sure that as I found my feet in training all those years ago, I wasn't perfect BUT this is ludicrous.

Schools are now being told that they must only accept training from OFSTED's approved list - ironic because the HSE is responsible for approving companies, nobody else. However, they want to regulate the paediatric side of training (not covered by HSE - yet) and this has led, in my opinion, to the downfall of a legal requirement that ensures they have adequate first aid cover for staff. A school that wishes to comply and get a good OFSTED report will need to send their people out to do a 2 day (twelve hour) course. The cost of this is astronomical (around £50 to £100 per head) and the value of what they actually learn and retain is debatable. Even people with a full 4 day's training and who are 'qualified' can turn out to be inadequate when it comes to the crunch, simply because of the quality of their lessons, the information (such as the drivel I highlighted above) given and the poor retention of skills and knowledge over the 3 years that they must have them (no practise, you see). It appears that many training organisations are so busy telling first aiders what they can't do that the whole point of them being trained at all rides off into the mist.

All of this may mean nothing to you but it makes our jobs difficult sometimes, as you know from my recent posts, and it smacks of someone, somewhere making millions for a low standard of training - in schools and elsewhere.

A qualified first aider is legally responsible for the emergency care of colleagues in the workplace. He or she must carry out their skills responsibly and with a degree of competency in order to potentially save a life and prevent loss of earnings (for employer and employee) through unnecessary sickness. This isn't happening and across the country you will see glaring examples of ignorance and apathy. Companies who have no first aider on duty are breaking the law and some of the biggest culprits are the biggest companies. If you have an accident in one of their premises and find this out, sue the arse off them, they deserve the punishment for their complacency (legally they dont have to take care of visitors to their site but they still have a duty of care, so they will settle out of court through fear).

First aiders who sat through their course yawning and whining about how hard it was, should not be doing the job. They had a choice not to be on the course in the first place; they just didn't know it because their boss bullied them into doing it.

If you are a qualified first aider in the workplace, get your act together if you haven't already because you will get caught out and it will be someone's father, mother, sister or brother who pays the price for your reluctance to practise and take seriously your role. Do a little reading up every month; pretend to resuscitate something - anything. Carry out the recovery position and get that damned elevation sling that you are useless at, right!

For those of you that know what you are doing (and I've met many of you), well done and be proud. First aid training is essential because it removes the fear and ignorance of taking care of others. Our ambulance services are in a mess because our kids know nothing of it and will simply pass the buck to a 999 call on the basis that they 'didn't know what else to do'.

In the public domain, there is no legal duty of care for you - its a matter of human principle to help people in trouble or get stuck in and do your best. You cannot be sued for trying to save someone unless you attempt to do it by methods that you are untrained in.

Whatever you feel about this subject, this is my personal opinion, but it is based on almost two decades of experience, learning and teaching.

I'm bored now.... your turn!


Friday, 17 July 2009


Night shift: Nine calls; all by ambulance.

Stats: 2 eTOH; 2 Abdo pain; 1 Emotional person; 1 Head injury; 1 Hyperventilation; 1 RTC with multiple casualties; 1 SOB.

The last of my run of nights and an interesting one to end with (although tragic also).

Of course it all starts with the obligatory drunk, which is given as a cardiac arrest, making me rush 3 miles in the hope of saving a life. I stopped at what I thought was the location of the call when I saw an ambulance parked up. I get out, chat to the crew and am informed that this is not a cardiac arrest – it’s a collapse outside a pub. Tsk! I think… but then I’m told that the crew’s CAD number is not the same as mine, so I realise I’m actually not where I’m supposed to be!

Another half mile up the road and I land where the real ‘cardiac arrest’ is; there are two ambulances and a small crowd around someone on the ground. Fortunately and kind of predictably, the man being carted off on the trolley bed by the first crew on scene, is not dying or dead… he is also drunk. A cricket fan of an age where he really should know better, has crumpled to the pavement after having way too many drinks on top of the nail-biting excitement of a day’s cricket. If you are a cricket fan, you must forgive my sarcasm; I’ve never seen the attraction to be honest. Balls, bits of wood, impractical whites and lots of running and shouting.

Oh well, the next call, to a 38 year-old with abdo pain but who called it in as chest pain, reminded me that my night was just routine and that an over-the-top performance of pain, which I could predict was coming just by reading the person’s name before I got there, would settle me down. She lay on the sofa while her child staggered about in the front room. Only when I touched her to carry out obs did she refer to pain and even then her demonstration was weak and unconvincing. She may have had discomfort (I don’t know for sure of course) but she really needed to play the game properly in order for me to assess it; just telling me she had ‘too much pain’ or ‘pain all over’ or that her score was 10 out of 10, regardless of the fact that she had given birth and surely that was more painful, was not good enough.

Her husband/father (who knew?) stood and shouted at me because he too was fed up with her wailing and rolling around on cue but I wasn’t in the mood for verbal abuse and, as he translated my questions to her, I asked him, quite firmly, not to raise his voice at me. It was all very complicated for no reason.

In the end, as she was taken to the ambulance by a crew with the same resigned look on their faces as I had, the man apologised and we shook on the basis that neither one of us held any high regard for the woman’s display of agony when we both knew it was fake.

Then an emotional Brazilian cleaner (who spoke no English either) feigned a ‘collapse’ at work and I was summoned, with an unnecessary ambulance, to say ‘there, there’. She had problems at home and, much as I would love to sympathise, we can all have those, so I asked the first aider on scene why he thought it was an emergency and he sheepishly admitted that his hands were tied by the possibility of litigation if he got this wrong. A fair comment but, once again, why bother with the training and qualification of First Aid at Work when you can’t use the responsibility and decision-making power that is given with it?

An ambulance was arriving on scene as I pulled up to rescue a drunken 37 year-old woman who had fallen and ‘couldn’t walk’. Worried MOPs had dialled 999 of course.

The next call, given as asthma, was a 27 year-old man who was hyperventilating. The crew was on scene and my trip had been pointless. I wandered down to A&E after that and visited for a while. Outside the doors sat a crying woman with a cigarette in her hand. She was an alcoholic with blackened fingers and yellow teeth and, as she sat there sobbing into her ciggie, I felt she epitomised the world within that department perfectly. In fact, she could have been the advertisement for it; a modern day figurehead for the NHS.

Further out in the north, a diminutive Chinese man lies on the ground in a little car park with MOPS who need to worry about him because he’s there. The man is so drunk it is difficult to keep him awake even when I get a response – he vomits so close to my boots I’m thinking about a career change and then he’s scraped up by the crew when they arrive.

The big job of the night is a multi-casualty RTC in which a moped rider and his pillion passenger (only one of which has a helmet on) crash at high speed into the back of a car as they jolly about in the crowded clubland area of East London. The front wheel comes off their ride and they are propelled, still on the bike, across a pedestrian area, hitting two people as they travel. The bike comes to rest under a taxi and both men are lodged there too. One of them is in a critical state when I arrive and a crew is working on him, so I am left to work out what is wrong with the other guy, who seems oblivious to the fact that he has been involved in a pretty terrible mess. A woman claws and paws at him as if she’s known him all her life but she is just a MOP who’s drunk and a little bit stupid because she’s ankle deep in petrol from the crippled bike and wont leave the man alone, even though I raise my voice several times and tell her to go away.

‘But he’s hurt, I need to be with him’, she wails without conviction or any territorial right.

I get a police officer to divide her from the injured man as I assess his condition. The only diagnosis I can come to is ‘drunk’ and he tells me he is ‘okay’ over and over again. He’s wedged under the taxi and obstructing the work being done on his erstwhile mate, whose condition continues to deteriorate. Keeping the badly injured man's head in place is a nightmare (this was being done by an observer) because space is very limited and my patient insists on trying to get up and walk off.

The third patient (one of the pedestrians) has a minor head injury and is left sitting against a post until more help arrives. The fourth casualty never makes an appearance and I only know he or she existed because I was told – walking wounded that walked off probably.

The critical man’s breathing is becoming laboured and slow and his level of consciousness drops dramatically until his eyes roll in his head and he begins to leave the land of the living. It’s not looking good. He has multiple serious leg injuries, some of which are so obvious they make you cringe just looking at them – totalled knee-caps are not a pretty sight for anyone.

HEMS arrive on scene after the man is taken into the ambulance – they are redirected as they descend on my patient. I have a crew with me now and we are trying to plan the move for him. I’ve checked him as much as possible but I’ve missed something. As we move him onto the scoop, I feel his lower leg bend unnaturally just above the ankle. He has a fractured tib and fib and his leg has become a jelly down there. Directions to straighten his leg are quickly cancelled as I realise just what the damage is and what it will become if he continues to obey and flex the muscles. He can’t feel a thing because he’s too drunk to know better.

Eventually he too is packed away in an ambulance and I return to the dying man at the roadside. The HEMS doctors are working away and I become part of the team until he goes to hospital. His chest is drained on the spot but he continues to slide into Neverland. So much damage has been done that when he gets to hospital, he’s in cardiac arrest and the only way they can hope to save him is by opening his chest cavity and trying to reach the bleeding artery within. Its all done there and then on the trolley bed in Resus – its brutal and a last ditch attempt… and it fails.

The accident scene was dangerous because of the people around and that large pool of petrol; a spark from any source would have sent us up in flames. The stink of the fuel sticks to me for the rest of the shift. I looked around as we prepared to leave it and all I could see was the debris of misadventure spread all over the road and pavement area – this was a lethal smash and getting out alive would have been a slim possibility anyway.

Back in reality, a 63 year-old man claiming abdo pain after telling the 9’s calltaker he had shortness of breath, got himself an ambulance and little sympathy from anyone, especially the hostel manager. He does this all the time apparently; claims life-threatening illnesses to get an ambulance and then reports nothing more than abdo pain. I travelled 4 miles to hear him tell me this.

No patient contact on the last call to a 23 year-old woman claiming ‘heavy breathing’. I was unable to find the address so left it with the crew when they arrived. Maybe she was making a phone call.

The night’s big job had drained me, so I was glad to be shot of it and go home. Tragic as it was, the event was self-inflicted and nobody can stop the stupidity of those who wish to take risks with their lives and lose. The toll on us, however, is stress and the frustration that we can’t do anything to help. The teamwork was amazing and the officer that turned up to help was very supportive – he didn’t get in the way, he just let us do our jobs. My patient ended up on the critical list himself – he had other injuries that could not be seen. He was far too drunk to be assessed properly and far too drunk to be riding a bicycle, never mind a motorised one.

Be safe.

Thursday, 16 July 2009


Night shift: Five calls; one assisted-only, one conveyed and three by ambulance.

Stats: 1 Faint; 1 Assault; 1 DIB; 1 Head injury; 1 Asleep.

Another night during which I supervised the progression of the SP with me.

The faint occurred at a very nice hotel in Mayfair (aren’t they all in that area?). The 27 year-old woman member of staff has a history of low BP and this is probably what caused her collapse, so she was left with her colleagues and sent home by taxi. While the SP carried out the last of the obs and did the paperwork I found myself at a loose end and so I asked about the penthouse suite and was told that it went for £7,500 per night and that a couple of rich guests had actually been fighting over who would get it. You know you’ve made it in life when all you have to argue about is the possibility of getting into a suite that costs more for a night than most of us can earn in months.

A call to a small street in the West End next, for a man with chest pain and a young woman who’d been assaulted when a fight broke out in the street and spilled into a shop. Actually, it wasn’t a fight; by all accounts, the girl’s boyfriend had been set upon by a gang of youths as he innocently talked on his mobile outside the premises. The thugs had deliberately provoked him by pushing him as they passed. He spoke up for himself and was beaten up for his trouble. Now, I have the same nature so I understand this. If I get pushed like that, to provoke me, then I’m afraid I will throw this biblical ‘turn the other cheek’ thing on its head and retaliate. The problem, however, is that you can end up being overwhelmed by feet and fists or even stabbed to death these days, so the risk seems disproportionate to the pride issue. Nevertheless, I still understand this young man’s need to defend himself.

The fight started in the street and crashed through the glass door of the little shop, where we found the owner suffering chest pain, probably as the result of the high stress he’d experienced. He was given priority for treatment when the ambulance arrived.

The girl had a cut foot and had been pushed violently against a large fridge when one the gang’s girlfriends decided to make an appearance and chip in. Gang-forced violence is ugly enough but when the women get involved on the back of their male counterparts’ testosterone, it’s even uglier.

The SP dealt with both patients, so she gained experience in mini-triage and multiple casualty situations (even small-scale is good practise). Then her boyfriend appeared out of the back of a police car (they’d been taking him around the area to try and identify his assailants). She hadn’t known where he was and a little concern crept in as we started to think about why he’d disappeared suddenly. The thought of him lying in some side street with a stab wound occurred and so it was a relief when he showed up. Now the SP had another patient to deal with.

We took both of them to hospital in the car; they had minor cuts and bruises, so it was safe to go that way. There were no ambulances to spare anyway.

Anyone with a history of DVT presenting with shortness of breath should go to hospital and so the 32 year-old woman who called us for DIB was taken from her hostel by ambulance after we’d started the obs and listened to her story of increasingly difficult breathing. It would have been easy to dismiss because she seemed fine and her breathing was good but, as I said, the history gives rise to caution here.

Outside, as I sat in the car waiting for the SP to complete her paperwork in the back of the ambulance (and being keen to do her best, she also wanted to continue her care of the patient and see the ECG), the rain was coming down in sheets – hard and violent, bouncing off the street as it landed. I watched this in the dimming light of the evening and, as if by some design of irony, an aboriginal woman appeared around the corner and walked past me. She was no more than 5 feet tall and had no umbrella. It would have been strange enough on a calm night but there she was, walking in this awful rain and completely out of place. I notice these little things and they click and whirr in my brain as if they are important sometimes.

We spent over an hour at an underground station late at night tending to a very drunk man who’d fallen quite a distance down the escalators, sustaining a head injury which was mostly facial. His cheek and nose were fractured and his eye socket was swelling and darkening. He kept trying to slip into unconsciousness and there were no ambulances at all for him; all he had was me, the SP, underground staff (who did an outstanding job) and two British Transport Police officers, one of whom became my drip stand.

The fluids kept the man awake and he giggled and apologised his way through the time we were with him. I could do nothing else but monitor him and we’d carried out constant obs to ensure that he didn’t deteriorate unnecessarily. At one point he coughed blood into my face and I got some of that in my eyes and mouth – there was an uncomfortable silence as I, and everyone around, waited for the result of my temporary shock-freeze. I was handed an antiseptic wipe and that was enough to clear the worries from my face. It’s happened before and it’ll happen again and he didn’t mean it. I have a good immune system, so I’ll trust it.

The crew arrived and we got on with the job of collaring him, boarding and moving him all the way to the top of the escalators and out to the ambulance. He was still conscious but we had no idea what was happening inside his head, so he was ‘blued’ in.

The last call of the shift took us to Park Lane for an ‘unconscious’ woman who was lying in the street in the early hours of the morning. The caller stated that he had to go to work so couldn’t stop and check to see if she was alright. What happened to chivalry and the care of others?

We arrived to find her sleeping on the pavement, with her handbag and purse out for all to see (and steal if they wanted to). Her trousers were unzipped (not sure why) and she sat bolt upright as we approached her. Within seconds she was wide awake and worrying about being dragged to hospital. That was never going to happen – she was a 25 year-old woman who’d got drunk and fallen asleep outside near a main road. She didn’t need us and no obs were necessary; the SP ensured she got safely into a taxi to go home. She wasn’t ill, she was vulnerable.

Be safe.

Wednesday, 15 July 2009

Hamiflu to be stockpiled in UK

Night shift: Six calls; one no trace, two by car and possibly only one by ambulance.

Stats: 2 Hyperventilations; 1 Febrile child; 1 Head injury; 1 Sore throat.

She's lying on the street vomiting. Her flushed face indicates a temperature change and she has no idea where she is or what she's doing here. Only three hours earlier, she was a fit, healthy and completely lucid human being. Now she is reduced to this. Her limbs are heavy and painful to move and her vision is so blurred she is almost blind. Her confused brain keeps saying the same things over and over again ('help me, help me') and her friends gather around her in deep shock as she deteriorates to unconsciousness. A 999 call will save her but only if it is made now and with 'chest pain' or 'DIB' thrown in. Yes, folks, she is suffering from the most deadly virus known to man and it's spreading to all cultures of society around the world - its WINE FLU and 'Hamiflu' is the only cure... possibly (that or sensible drinking).

Sorry, I couldn't resist. I used the phrase on a night shift as I helped a crew with yet another drunken waster and it stuck. I felt I had to share it with you. I'm not undermining Swine Flu, so don't climb on that soapbox.

The first patient was probably not taken to hospital but I left before the crew made that decision. The 28 year-old woman was having a panic attack after travelling to a train station to meet her husband. I don’t know if the excitement of meeting up with him was the predisposing factor, or the fact that the station was a little hot but she was still hyperventilating twenty minutes after she’d met him. I wish I had that affect on women.

Three cancellations followed in swift succession for similar ‘faints’ in the area; it was one of those nights.

When a child is ill, with a high temperature and has a fit, it is very likely to be a febrile event and not a major concern for us, so the 10 month-old baby with these signs and symptoms and ‘blue lips’ was a NPC for me because the crew rolled up at the same time.

The first drunk of the night had a head injury after falling onto the pub floor. The bar staff was concerned about possible litigation, mistaking him for a lawyer (he was an accountant – same astronomical fees, different objectives) but his minor scalp wound needed no more than a little dressing and a short trip by car to A&E for closing. He was very drunk and the night was yet young; grown up people make the same mistake with alcohol that younger folk do and it continues to astonish me. He rode in the back of the car with a woman he was ‘friends’ with.

In a car, parked up in a side street in Chinatown, a 22 year-old man panicked as his girlfriend worried over his life. He had asthma and was so convinced that his condition was immediately threatening that he kept prodding his arm in a ‘give me a shot’ type of mime. He’d been given adrenaline the last time he had one of his attacks, I was told but I assured him that he wouldn’t be getting one now. Neither was he getting much more than a neb, even though his problem was hyperventilation – a small dose of Salbutamol wasn’t going to help him but it wasn’t going to harm him either. The psychological effect was immediate and he calmed down enough, after leaning out of the door three times to vomit, to accept that he was getting better.

The crew took the job further and within ten minutes had him smiling again with no treatment required. Again, he didn’t need to go to hospital, so he was allowed to continue his night with his girl. He beamed at me as I sat in the car writing my PRF. His thumbs-up signalled that all was good and I felt that I’d probably saved his dignity, even if I hadn’t been needed for anything else.

Then the most ridiculous call of the night – possibly the month, from a 17 year-old boy staying at a hostel who got one of his girlfriends to call an ambulance because he was having difficulty breathing and ‘could not speak’ and had (let’s chuck it in) ‘chest pain’. He met me at the door of the grubby place and stood talking at some length about his current medical emergency, for which an ambulance was surely en route.

‘I have a sore throat and haven’t eaten for three days’, he tells me.

I gave him my now well-known ‘so?’ look and he almost looked shocked that I hadn’t got out the resus bag for him. Instead I went to the car and cancelled the valuable crew so that they could go hunt for a Red3 drunken emergency or something.

I decided to take him to A&E myself, rather than stand in the doorway arguing with him about what a life or death emergency was and trying to explain to him what the word ‘infection’ meant. He’d already been diagnosed and had the pills to prove it but no, he insisted his life was in jeopardy. ‘What if I die?’ he asked me. ‘You will, eventually’, I thought.

The beginning of this comical convo initiated with him passing me his mobile phone so that his girlfriend could explain to me what was wrong with him (because he couldn’t speak). I felt stupid standing there with him right in front of me as a young lady told me his symptoms. Then I lost patience and handed the phone back to him, telling him to talk to me himself and not by proxy.

Nothing was said by me on the way to hospital because I was quite annoyed with him I’m afraid to say, but he moaned a lot from the back seat – mainly about how bad his throat felt and how his life had taken this dramatic turn for the worse. I really believe he’d never experienced illness of any kind before or that his comfy, protected life was being ripped from him now that he was on his own in traveller’s land.

The no trace call was for a 29 year-old who’d been bitten by an insect and thought she might be reacting to it. It was an early morning job and the park where I’d been sent was deserted except for a few sleepers (some in bags, some not) who’d decided grass was good.

The crew joined me in the fruitless search for the insect-bitten victim but all we managed to do was wake a French man up from his slumber beneath the trees of the great park. ‘Parlez-vous Francais?’ he said, after I’d asked him, in a language he couldn’t understand, if he’d seen a distraught woman around recently. Even in French it would have been a question open to the worst jokes and one-liners possible. So, we let him carry on sleeping and considered that she must have gone home and thought better of her hysteria.

This is a message to all insects out there (it’s possible a few of you read this) – please don’t bite people at 5am ‘cos it’s not even dinner time and they will all think they are anaphylactic when the first bump on their face appears. At least carry Piriton with you (under you wing or around your little legs) so that you can offer a remedy for the panic that will ensue.

Be safe.

Tuesday, 14 July 2009


Okay, you are drunk and need the night bus home. You know its the N155 you need...oh wait, is it the N551? Oh no, what would you do? Thought you'd like to share the confusion. Taken by Lottiecam.

Night shift: Five calls; one treated on scene, one assisted-only and three by ambulance.

Stats: 2 Hyperventilations; 1 Chest pain; 1 Hyperglycaemic; 1 eTOH.

The Student Paramedic I’m supervising was out again with me tonight, so I did the driving and the watching.

What is it with panicky people? We are getting lots of calls for supposed ‘DIB’ and ‘chest pain’ where young people, who clinically should present with neither (normally), are hyperventilating and unable or unwilling to accept that there is nothing we can do for them. It doesn’t commonly kill you and it’s a hugely emotional thing, so calming them down is a job that could and should be done by the first aider on scene (at workplaces) or responsible adults when they recognise it.

So, the 16 year-old German girl who was breathing too fast for her own good after panicking when the lift became full at an underground station, could have been treated by her adult carers (both teachers) but, for some reason, the simplicity of it all was beyond them. It’s not rocket science.

I tried to cancel the ambulance but it was impossible to get a signal so far down in the bowels of the place, so I had to do it ‘manually’ (i.e. told them) when the crew actually turned up. Then it was simply a case of waiting while we calmed this teenager down and that cost a lot of minutes while other, possibly more emergent, calls were being held.

The chest pain call was indigestion. A 26 year-old Indian man, who was learning how to binge-drink as per the British way of life, fell afoul of the excess and his body resisted, mainly by chucking lots of hydrochloric acid, potassium chloride and salt into his stomach and oesophagus, producing the tell-tale lower chest pain that can mimic the cardiac kind. But at his age, it was unlikely to be a heart attack and we knew it as we sailed towards him.

He and his friend acknowledged this and when the crew arrived, they accepted the possibility that he’d just gone too far with the booze. In reply, they both seemed to triumph at their achievement of becoming truly one of the natives in getting drunk very fast. I’m so proud to be British; we export so much that is of value. I said three years ago when I wrote ‘Drunken Chinamen’ that we were heading for a nationally-induced change in international drinking habits....the Chinese and Indians (mainly visiting students) are in on the act already, watch this space for other nationalities.

While we sat on Oxford Street contemplating this, a small Asian lady approached the car and told me that her blood sugar was high – she said she was diabetic and felt a bit hyper, so the SP checked her out and found her BM to be a little high. Not enough to call out the frontline might of the NHS but enough for some friendly clinical advice and a smile. She was happy with that and was left in the care of her family.

Depression, as I know and have repeatedly been reminded of by those who seek to find a chink in my armour is a serious problem and very common but it is also the domain of those in need of nothing more than attention, regardless of the cost and humiliation to themselves and others (mainly others). I’ve lived with it (as the person’s other half) and I know this first-hand; it can be a hole to hide inside when things aren’t going right for you or there isn’t enough care being shown towards you. So, the emergency call for a woman suffering life-threatening asthma and who was lying flat on the bed when we saw her made me think immediately of someone who had other problems. Her demeanour, the way she was exaggerating her condition and insisting it was critical asthma, the fact that she could lie flat with supposed asthma and her boyfriend’s regulated concern (she was visiting him) had me on high alert for another wasted 999 call.

It took less than a minute to establish that she had ‘depression’ and other issues which required medication. She wasn’t having an asthma attack of course; she was forcing hyperventilation and refused to believe anything else we told her about the condition. She refused to calm down and insisted that she needed an ambulance, so one duly arrived and the crew recognised what every one of us recognise in individuals with needs beyond our remit.

Self-pity charades put real asthma sufferers and those with genuine clinical depression in danger, in my opinion. This lady was an alcoholic who’d just finished off two bottles of wine that evening (nice way to say hello to her boyfriend) and she sat up, breathed deliberately fast and made grunting animal sounds with her throat every now and then, punctuating any silence that was allowed.

‘I think I need a Fisherman’s Friend’, she said out of the blue.

You know what, I’m not even gonna end this story with what I had in mind. You can do it...comments welcome!

In the midst of all the calls, there were so many cancellations and wasted trips it’s not worth bothering about them here – except to say that much of course. And as we sat on stand-by in Leicester Square, watching the crowds milling by, a sudden dramatic cloudburst sent them all squealing and scattering in all directions. The rain flashed down for about 5 minutes and then it was all over.

One of the wasted journeys was to a baby, given as DIB of course, who was just very tired. The poor thing just wanted to sleep and the crew on scene had no choice but to take her because she’d been diagnosed with an infection and given a Tamiflu injection ‘just in case’ earlier on.

Meanwhile, back on the Square and right after the cloudburst (which was entertaining), an Italian man with poor English, by his own admission but also by evidence when he spoke, enquired about an earlier assault on his person involving a car, some youths in said car and a high-speed egg.

‘Excuse but I got car threw a egg at me.’

‘Oh really, well you need the police for that.’

‘Ahhh, police, okay.’ Then he rubs his hurting arm and reflects a little (in Italian I guess).

‘’It’s only a egg but, you know... is dangerous.’ He said with a sad voice – the voice of someone who has just realised that pursuing this any further is hopeless.

We both smiled as he walked away but I took his hurt seriously. Being hit by a flying object (especially a hard egg) at speed after it has been lobbed out the window of a moving vehicle by one, two or multiple street gorillas, is not funny (it's no yoke in fact) and, I have to agree, can be quite dangerous.

Oh but the Italian hilarity had to end and we were off to a 25 year-old man who was lying in a doorway in Soho after taking too much alcohol and possibly a hit of GHB. His friends were on scene and one of them in particular wasn’t impressed when I suggested we start a ‘name and shame’ campaign in which the details of everyone in this state who needed an ambulance would be published for all to see.

‘I’d do that if I had my way’, I’d said with a smile, to be friendly.

‘Yeah, your way’, the woman said with a tang of distaste and the sting of someone who felt I was being a judgmental prat.

I thought about her response for a few seconds and I realised that she truly believed her friend’s condition was brought about by fate, or the Gods or the local Council but NOT by his own doing. Therefore my comment would certainly be judgmental without any basis, right?

I asked her what she did for a living. I wanted to gauge what kind of person thinks this is right and that any punishment for the cost involved or even a warning off could be wrong.

‘I’m a teacher’, she told me.

Bravo. Now we have teachers who trust in their mates rather than the obvious. You go out, you drink lots, you take illegal drugs, you fall down, you become unconscious and you vomit... possibly die. It’s not their fault, they are misguided and society doesn’t do enough to help them. It’s the Government’s fault. It’s my fault for being a paramedic that gives a toss about real issues and real people with genuine problems but not too much about drunken idiots. I come across as the pedantic judgmental type because of people like her. It’s not hatred, it’s not bitterness (you are off base with that one) and it’s not being fed up with my job (which I still love) – it’s me being exactly who I am when faced with weakness, stupidity and costly self-abuse. I'm the same at home - even Scruffs dares not behave stupidly or selfishly.

I’m still smiling here.

Be safe.

Monday, 13 July 2009

Too early in the day for mad people

Another pierced person. Photographed with permission.

Day shift: Six calls; one treated on scene, one by car and the rest by ambulance.

Stats: 1 Cut scalp; 1 Impaled thumb; 1 eTOH; 1 Psychiatric problems; 1 Faint; 1 RTC.

I’m doing a bit of overtime, so am struggling to keep up with the posts on time. I’m currently using the time I can afford while my extended family are visiting to complete as many of these reports as possible, in-between showing my face and trying not to be rude, although they all know that I, like Scruffs (who is hiding in the bedroom), am not the most socially-friendly person, especially when all the kids descend. I’m not being obtuse, I’m just being me.

The first call of the day was to a 67 year-old with a cut scalp at an underground station after he caught his head on the closing doors of the tube train. He had the most minor graze imaginable and yet the first aid (qualified first aider) person decided it was worthy of a 999 call. The poor guy, who was on his way to work, was very embarrassed. I applied a plaster and he went on his way. The first aider could have done that! And please don’t annoy me with stories of liability or of not being sure, etc. If you do the training and you qualify, why don’t you take the role seriously?

A 27 year-old scaffolder managed to get a barbed piece of metal hooked through his thumb, to a decent depth as he dismantled scaffolding at a gallery. The metal bracket attached to the wire that ran into his digit was still hanging from it when I arrived, so I took care of that by having it cut free, leaving only the protruding metal extension – small but sharp and nasty. I didn’t need an ambulance for this but today was one of those days where nobody seemed to be listening, either to me or to the MRU control desk, so a crew turned up anyway, wasting more resources than necessary for such a minor thing.

A fellow Scot, Glaswegian and drunk, discharged himself from hospital after a diagnosis of internal bleeding was apparently made. The 50 year-old, who obviously thought I was his best mate (brother even) after establishing my roots, wouldn’t go back and was being persuaded gently by the PCSO’s around him and less gently (quite aggressively) by a man that had ‘befriended’ him earlier. In fact, as the PCSO in charge was telling me his story, I distinctly heard the unknown man threaten the patient. I pointed this out to the PCSO, who hadn’t heard it and the man was quickly removed from the scene.

It took a long time for me to persuade the man to go to hospital. He was homeless, teary-eyed and repeatedly wanted to get me closer for a ‘confidential’ chat, in which he’d simply say the same thing every time – ‘I’m ashamed’.

A possibly hydrophobic 25 year-old, described on my MDT as ‘foaming at the mouth’ was having a nervous breakdown and there was nothing I could do to help. He was inside a hostel and he wasn’t friendly – the police were on scene and they warned me not to go near him. Great, I could have done with this advice before I was sent alone to ‘treat’ him. He had to be cuffed and dragged out by the officers when the ambulance arrived.

A fainting 45 year-old walked into her GP surgery and performed a dying swan act across the reception chairs. She had a history of collapse, with no known cause after every test in the world had been performed on her, so her doctor, who was waiting for me when I arrived, stood doing nothing much because there simply wasn’t anything to do. I did all my baseline stuff and found nothing untoward and then she decided to fake a fit on me. Honestly, there was nothing in her little shake-about that convinced me or the doctor that she was in any trouble but it helped her friend get more worried and it turned out to be something she does regularly but hadn’t yet bothered to tell her GP about. It got at least one person's attention (her mate).

Not to be outdone by her performance and the fact that I had to be seen to act, I pushed a cannula into her vein. You never know, I may have been looking at a true seizure but miscalculated it through lack of compassion, so it was best to keep a vein open for a class A drug, knowing that it would never be needed.

Sure enough, she ‘recovered’ within ten seconds of jerking and twitching and was taken to hospital, fully alert and looking fairly healthy, for more tests that would probably show nothing was wrong. I know - I’m a cynic and should be shot at dawn – go get your guns.

The last call of the shift was to assist a colleague who was on scene with a man who managed to get squashed against his car door when a bus reversed into it as he opened it to get out (you'd think he'd have seen that coming). He suffered a badly cut hand and a leg injury, which may or may not have been a fracture (if it was, it was only a chipped bone but still an x-ray job). I was asked to convey him because there were no ambulances available and he could hop on it (the leg).

He faffed about so much that I was getting a bit frustrated. I wanted to get home on time for once and now I was late while he deliberated whether to go to hospital or not, or where his car would be kept and whether he could risk parking it, blah blah blah. It took a full twenty minutes for him to decide that A&E would be a good idea. His chauffeur and car were ready...had been for ages.

Be safe.

Friday, 10 July 2009

Fire and smoke

Night shift: Nine calls; one false alarm, one by car and the rest by ambulance.

Stats: 1 Dizzy person; 1 Allergic reaction; 1 RTC; 1 Chest pain; 1 Unknown problem; 1 ? Fit; 3 eTOH.

Here we go with night shifts again. You know I love them. A major fire in Soho meant that my car was stinking of smoke after it had been ‘on scene’ all day – no matter what I did to freshen it up, I couldn’t shift that lingering aroma. Ash stuck to the outside of the vehicle and contaminated a lot of the equipment inside too, so I was busy cleaning up for the first hour.

The dizzy person was a 30 year-old man who’d been smoking a Hookah outside a restaurant after taking a load of Ephedrine, a drug that can mimic the effects of epinephrine. He didn’t feel well (surprisingly) and as I handed over to the crew he was made to stand up by his friend – possibly in preparation for the walk to the ambulance – but promptly fell down on the ground behind us.

Then into a posh apartment block lobby in the expectation that the 20 year-old female who’d called an ambulance for an allergic reaction had informed the concierge that I was coming. Nope.

I stood there like a lemon because she hadn’t given her apartment number and nobody knew what was going on. It was another case of a rich person using us like servants – dialling 999, waiting til we arrive and then appearing when she felt like it without a word or a warning. She drifted down the stairs with her friend, her face covered to hide the hives and swept by me as I sat in the lobby waiting for an update on where the hell she was. The crew had arrived outside and were waiting too. She must have seen the ambulance and delivered herself to them without bothering about me. I didn’t even know she was the patient until the concierge pointed out the possibility as she exited the building.

I chased after her but she had already made her way into the ambulance and the crew began her treatment for a puffy face and red skin. I think I’ve become invisible.

A RTC later on and a 25 year-old lawyer, who’d been up late drinking in her office, was lying on the road after having been hit by a black cab on a pedestrian crossing. She’d been lifted into the air and slammed back to earth without losing consciousness. In fact, all she’d lost temporarily was a shoe. She had facial injuries and an obvious broken wrist. MOPs were milling around her when I arrived and it took a few seconds to establish that they had nothing to do with her, so I asked them to move away because they were obstructing my efforts to get the facts about the accident. The crew weren’t too long in arriving and all I had to do was keep her neck stable until we collared and boarded her.

She spent a few weepy moments in the back of the ambulance telling her friend (on her mobile) that she’d been knocked down. I sympathised; it must be a shock to the system, drunk or sober, to get whacked out of the blue by a fast travelling vehicle.

A windmilling 20 year-old man claiming chest pain outside a cinema confessed to being a substance abuser and alcoholic (he’s only twenty!) but only when he was in the privacy of the back seat of the car. He even asked me to move away so that his friends wouldn’t see him as they came out of the cinema building. He’d been in there watching a flick when the pain had started and it all sounded like withdrawal syndrome to me. He was tachycardic but stable, so I took him in the car.

In Oxford Street, a sleeping drunk caused mild panic when a MOP came across him, so 999 was dialled and I was sent to check it out on the premise that he might be dead, of course. I looked across at him in the shop doorway and suggested that he was (a) drunk and (b) asleep and (c) possibly not interested in my help but the worried MOP continued to harass me into ‘helping’ him somehow. Okay, I am paid to do this and I guess I should never ever be complacent (and I’m not, I just come across that way sometimes), so I obliged and went over to awaken my slumbering friend. I discovered that he was (a) drunk, (b) asleep and, at the high risk of getting a punch in the face, (c) not interested in my help. Job done. Oh, and the cans of lager lying next to him should really have been the biggest of all clues in the first place.

Now, at the risk of sounding awfully pedantic, please be aware that people who look unconscious in doorways in public places on weekend nights tend to be (and are very highly likely to be) drunk and asleep – just like on all buses. Don’t dial 999 yet (because your sick granny really needs us) – go and see if he’s breathing, perhaps ask him if he needs help but keep a reasonable distance because he is very likely to spit, vomit or swing a punch in your general direction. It’s not my job, nor that of my colleagues to experience this stuff just because he looks untidy.

The next patient was in a private taxi outside a night club. She had a history of unexplained loss of consciousness and she’d performed that trick a few times tonight, worrying her friend. Yes, they’d both been drinking but there was something about her behaviour that made me think twice about dismissing her problem. She wasn’t 100% with it and there may be a cardiac link for that, so I calmed her and got an ambulance to take her to hospital.

The 25 year-old woman was clearly agitated up about her condition, which was yet to be diagnosed and when she got to A&E her friend burst into tears after a comment was made at the door (by a uniformed person) about her mate being ‘yet another drunk off the streets’. She saw this as unprofessional and hurtful – the assumption that her friend was drunk and incapable, just because she was young, dressed up and flopped onto a trolley bed on a weekend night, was obviously hurtful to her. I tried to explain that, unfortunately, the norm of these nights gave most of us the same impression about everyone fitting that description – especially if female, but I also recognised her indignation on behalf of her friend and supported her annoyance that the remark had been made at all. It was unnecessary and potentially inflammatory.

I made sure she was okay and promised myself that I would try harder not to judge every case with such indifference, even when I was emotionally drained and physically tired of it all. I didn’t want to make someone cry like that and I don’t want to be connected to the callousness of the person who made the remark. I will, of course, always define my disrespect for all drunken people who waste our time but I will try harder to weigh the facts up before passing personal judgment.

A General Broadcast went out for a 25 year-old female said to have been fitting for 20 minutes, so I took the call and sped off in case the woman died through lack of medical attention, thanks to the drunks and idiots of London. Unfortunately, my valour, bolstered by my new-found determination to do better for the truly ill, was wasted because she wasn’t fitting at all and I don’t think she ever had been. The police were on scene with her friend and none of the stories I heard confirmed a seizure, certainly not one lasting 20 minutes, so that was someone’s imagination at work for sure. In fact, she was drunk and my soul searched for more reasons to carry on being a good paramedic tonight.

Just to be sure that my faith in humanity was fully crushed the next call detailed the Red3 – life-threatening emergency call as ‘acute alcohol intoxication’. It didn’t even try to hide itself and pretend to be a DIB or chest pain. So, I found yet another 25 year-old female lying on the ground in a pool of her own vomit, with concerned friends around her. These people look upon their mates with true horror, as if a new and deadly virus has struck them down. They seem to have no idea that alcohol is the culprit. They honestly seem to have no clue about its ultimate effect. What is wrong with these people?

Prior to getting on scene, I was sent to the wrong location, on the other side of town. The ambulance arrived and we both looked lost – ‘cos we were. When the correct location was given, we travelled across to the West End and arrived to find another FRU on scene and a second ambulance pulling up. There you go – two ambulances and two FRUs for one stupid drunken woman with apparently ignorant friends and zero dignity or common sense (or is that too harsh?). I am counting the cost of all this in my head as we all gather around her as if she is a major incident. I reckon it’s about a grand’s worth of tax payer’s money. I want to send her the bill on our behalf but I don’t have an invoice handy.

As we discuss the stupidity of this duplicated call, she lies there looking drunk and the pool of vomit mocks her. The crews are undecided about who should take her – it’s all about who is finishing first today. As I watch this comical scene, I realise that nobody is doing any obs and it all seems unprofessional. But it isn’t; if she were in trouble, they would be all over her and saving her life, I promise you that. She is drunk and they have seen a million of her kind, so there’s no hurry to scrape her up. In fact, the longer she lies there with no sympathy, the more her friends will learn about how not to end their evenings. Its harsh and no doubt a few of my pedants will find a platform to scream from but there isn’t a single paramedic, technician, nurse or doctor out there who will disagree with the impact of that moment.

Finally, a drunken prisoner lying in a cell pretends to be unconscious. He stops the pretence when I wake him up; it’s that easy. There is a nurse on duty at this police station for some reason but obviously the prisoner knows that there is a difference and that trying to fool one is easier than the other. He had a bump to his head and went to hospital when the crew arrived, simply because of that. Otherwise he was wasting everyone’s time and looking for an excuse to get out of his filthy little home.

Be safe.

Thursday, 9 July 2009


Ouch! See below. Photo printed with permission.

Day shift: Three calls; one by car and two by ambulance.

Stats: 1 Nail through hand; 1 Faint; 1 Eye injury.

I had a Student Paramedic (SP) working with me today, so I mostly stood and watched as she attended the patients. I also drove a lot.

At a building site a 30 year-old man somehow persuaded a long nail to pierce his hand and travel all the way through the flesh until it appeared on the other side. Sexily known as a penetrating puncture wound, we arrived to find that not only was the nail part of his mitten, it was also still firmly attached to a long piece of wood.

The only access to the floor that he was on was by ladder and the small opening afforded no escape for him if he or his work colleagues had decided to move him to the ground floor; the plank he was stuck to was just too long and he would have become wedged, or worse still, suspended by it as he tried to get through. There was no option for me but to decide on the best way to shorten the plank…or remove the nail from it.

The only cutting tools around would cause so much vibration that he would be in great pain if any of them were used. He was in enough pain as it was and had to be given morphine in preparation for what was to come.

The Fire Brigade were called out for this job – I had considered the options and thought it best to use their skills in the hope that they’d be able to remove him from his wooden implant gently and skilfully, and when they arrived, in full force as usual, they used a small saw to slice through the nail itself, just below the entry point in his palm, so that he’d be free of the board but still have the offensive metal in his hand. It took them 15 minutes to think it through and just 10 seconds to perform the operation.

Once free, his hand was bound and slung so that he could be taken down to the ambulance with the crew, who’d arrived shortly after the LFB. It was all over in a short time but had been a delicately precise and long-deliberated task. Nevertheless, I was happy with the outcome and so was he. He went to A&E looking like thevictim of a botched crucifixion. I just hope he isn’t religious.

During our conversations, he told me that he’d been in a car crash a short time earlier (he still had a scarred face) and had lost his wallet prior to this incident, so his run of three for bad luck seemed to have come to an end here.

After that call and later on in the day, we were sent to a 1 year-old female who had a coat hanger in her eye. I thought we were about to go through the whole embedded foreign object scenario again but when we arrived the little girl was with her mum and was coat hanger free. She’d been playing with the metal object when the bent top end, which was sharp to the touch, had fallen into her eye, catching on the conjunctiva and hooking itself into it. She’d frantically pulled on it, tearing into the tissue and causing minor trauma, resulting in a swollen and red lower lid. We took her and her mum to hospital in the car but this little girl was a bit hyperactive and to amuse herself on the way she unlatched the door while I was driving. I had forgotten to put the child lock on but luckily mum was holding her and I was able to stop before she got bored and threw herself onto the pavement for a laugh.

The well-to-do Middle Eastern woman made me feel like a chauffeur rather than a paramedic. I got the distinct feeling that she saw me and my kind as merely servants and not medical professionals. Still, she and her little bundle of mischief were delivered safely to hospital as required, so I must have fulfilled the criteria even though I barely got acknowledgement of my assistance with her emergency. It’s nice to be noticed.

Prior to this incident, our 'faint' call took us to the side of a restaurant chef who claimed chest pain, dizziness and who was described as 'delusional' by our system (although I don't know if that came from him, his manager, the caller or the call-taker). It would be funny, but completely unprofessional of course, to be able to put a short description giving our opinions on the caller's condition, wouldn't it? It would be entirely human to put things like 'mad as a box of frogs' or 'pissed as a rat' or 'total arse' when describing certain individuals who dial 999 and demand our presence for emergency itchy bottoms and life-threatening fungal toe. Shame we don't have that sense of humour (well, we do...we just don't tell you).
Be safe.

Wednesday, 8 July 2009

Medic alert

Day shift: Three calls; two by car and one by ambulance.

Stats: 1 Near faint; 1 Dizzy person; 1 Heart attack.

A 39 year-old doctor who travelled a long way on the tube suddenly felt faint but didn’t quite go the distance and pass out. Initially he wanted to go home after all his obs showed how healthy he was but for some reason he changed his mind and began to worry about possible cardiac problems he may have developed (in the hour or so on the train I guess), so I took him to hospital and he lay on the back seat of the car, chatting nervously to his wife about his possible dramatic conditions. Differential diagnoses by proxy.

All the obs were normal again for my next patient, a 58 year-old man who felt dizzy at work. He had a bit of nausea too, so this prompted him to take the rest of the day off and keep me company as he travelled in the back to hospital. His history of hypertension must have given him cause for concern, despite his normal reading and the fact that he was looking very well as he entered A&E. The Swine-flu ridden 'panademic emergency area' (or, as we simply call it - the waiting room) was stuffed full but this didn't put my patient off at all.

The only real emergency call I took today was my last. An 88 year-old man lay in the street having a heart attack. He had a previous history of two MI’s and so he was being taken very seriously. A couple of very kind MOPs, a police officer and an off-duty nurse were on hand to help as I worked to keep him stable but his condition was deteriorating fast and there were no ambulances available (probably because they were tied up dealing with dizzy people and faints).

The busy crossing in which he lay provided endless entertainment and local drama for those wanting to move from one side of the street to the other and so I asked the MOPS, two young men who wouldn't leave him and wanted to help as much as possible, to give him a blanket screen for privacy. He grew paler and less alert and I had time, given that I was on scene with him for almost 40 minutes, to do a 12-lead ECG in the street. The result was pretty bad and there was no doubt that if he didn’t get to hospital soon, he’d become a work-in-progress for CPR.

Just as time was running out on us all, the crew arrived and he was taken to hospital for specialist treatment. One day soon, all my moans and groans about silly calls and time-wasting do-gooders who think we are simply a taxi service will be highlighted with the demise of a patient on the street like this. A lack of resources, caused primarily by the type of call that dominates our system will be to blame. In the meantime, I have to rely on luck and as much of my own judgment and skill as possible. Thank goodness for nick and time.

Be safe.

Sunday, 5 July 2009

Headless chickens

Day shift: Six calls; one assisted-only, one treated on scene, three by car and one by ambulance.

Stats: 1 ?Flu; 1 Abdo pain; 1 Burned foot; 1 Bee sting; 1 Cut scalp.

A beautiful sunny Sunday, marred only by the nature of the calls I had to deal with but, of course, that’s what I’m paid to do, apparently.

A 22 year-old man with ‘flu-like symptoms’ was attended to by the crew, who arrived with me, so I decided it was best not to get involved directly. He would be told to stay at home and get well soon… unless he insisted on going to hospital and you won’t believe how stupidly stubborn some people can be when it comes to their ‘rights’, so I expect there was a lively debate going on.

Then a call to a popular tourist area for a 32 year-old French man who was suffering abdo pain and looked very uncomfortable with it. At first there was a bit of confusion because the call I’d gone to was for an 80-something female who was ‘unwell’; I thought there might be two calls from the same area and, to be honest, this guy initially looked like he was hyperventilating, so I wasn’t desperate to give it a higher priority – it wasn’t until I started getting his story that I realised his condition might be worse than that. But I was concerned that some old lady was waiting for me somewhere nearby too, so the complex little scenario had me thinking on my feet. Oh, and to wrap it all up in a bow, neither he nor the family around him could speak much English, so I was once again forced to resort to my High School French, which is not great, even when I have had a drink of wine. Nevertheless, through badly constructed sentences and pidjin terminology, we managed to communicate effectively enough for me to establish that he did not have any serious medical conditions, was not suffering chest pain and had been through this before but, as yet, had not been diagnosed by his doctor.

It would have been cruel and unprofessional to say ‘avez-vous deux pieds?’ although it would have been nice to exercise my ‘parlais’; instead I offered to take him and his wife/sister/mother (I have no idea these days) to hospital in the car. Control had agreed with me that this was probably the one and only call from the area and that the confusion had been produced as the result of someone consulting a French-English dictionary as the call was taken, so off we all went.

At hospital, the man was given a cubicle and a bed and I was informed of the strong possibility that some old lady was still sitting in a nearby church hall (apparently), waiting for an ambulance or God to come and help her.

I also conveyed the next patient; a man with Parkinson’s who was very difficult to understand. The long journey south seemed wasted but he’d fallen a few hours earlier whilst on the loo and now he had leg pain, although he could weight-bear and move around with the help of his stick. It wasn’t an emergency really but the day was unfolding that way and, even with the pressure we are currently under, everyone’s ailment must have seemed important enough to dial 999. I just wish he’d cleaned the toilet before sending for us – it was an unpleasant sight to behold as I entered the little flat. He left it in a mess, even though he’d let hours go by and was quite able to clean it and himself.

But the call that took the biscuit was to a restaurant where a 24 year-old chef spilled hot soup onto his foot. He was sitting front of house with his damaged extremity in a bucket of water (which is the right thing to do). It had been soaking there for half an hour (also a good idea) and his colleague, a young woman who obviously ran the place, had decided to dial 999 and summon an emergency ambulance for it.

I’m sorry if I offend some of you with my attitude to this but if I burned my foot and had two blisters on it (which is all that he had), I’d pop a couple of paracetamol for the pain and elevate it for the rest of the day, applying Calamine as it healed over the next few days until the skin, which is perfectly capable of healing itself, repaired completely. That’s what I’d do. That’s what most of the population would do but I got an argument (and most likely a complaint made against me) for my ‘attitude’ when I asked her why she thought this was an emergency. I also asked her if she thought an ambulance would be better served going to someone’s heart attack but she was completely indifferent. In fact, she became so defensive that she ultimately made me believe that she thought of us as merely taxi drivers that should do as we are told and no more. If a doctor had arrived and queried her judgment, she probably wouldn’t have been so aggressive about it, and believe me, any doctor worth his or her salt, would have given her some grief. Let's be honest, a good nurse would have said the same.

‘If it is so minor, why didn’t they tell me not to bother with an ambulance when I called?’ she snapped.

‘Because they don’t do that – they send ambulances based on what you tell them and no more’, I answered.

The truth is, we have clinical decision makers who can sieve through calls like this and cancel ambulances but on this occasion it hadn’t been done – probably because they are too busy but the point I was trying to make was that she had called in the first place.

‘How am I supposed to know it’s not serious?’

She was making the ‘you are the professional and I know nothing about this stuff’ statement that I hear all too often. It’s a cop out because we all know what’s minor when it comes to this type of injury.

I cancelled the ambulance and took the man, who hadn’t even asked to go to hospital, to A&E, where he hobbled to the waiting area to do just that – wait. Even the triage nurse rolled her eyes when she saw the extent of his injury.

The next call was no better but I kind of understood it. I was sent miles away for a bee sting to the thumb. The patient was a 2 year-old girl and mum was just concerned about the possibility of her daughter puffing up and suffering a full-blown anaphylactic attack. They are from Africa and they believe that they can ‘catch’ these mostly Western diseases and problems just by being here – crazy really.

I checked the child’s thumb out – it was a tiny bit swollen; checked her airway and decided she needed no more than a smile, which she got and returned. Mum was happy too and I was able to leave them all to go out for the day, reassured that no bee was likely to kill her baby because, with her ethnic background, the chances were slim. This is a culture with hard-knocked immunity.

I have to admit I had a tear in my eye when I went to help the family of a 4 year-old boy who’d fallen and cut his scalp on the escalators at an underground station. His wound was very minor but the mum and dad (and grandmother) wanted to have it checked before they continued their journey. The little boy was very scared in case I did anything to hurt him, which I wouldn’t – I didn’t even do a BM, which is required of me for every child. I just put a makeshift bandage on his head and chatted to the family. I even managed to clumsily knock mum's head with my elbow as I tied the bandage on (whoops).

I am not pleased that grown up healthy people call ambulances for burned feet and other minor injuries and illnesses but I really don’t mind going to help a small boy with a little cut to his head who has just endured long and sickening chemotherapy for a brain tumour.

Be safe.

Saturday, 4 July 2009

Silly Saturday

Day shift: Four calls; one hoax, one false alarm, one assisted-only and one by car.

Stats: 1 Head injury; 1 Faint.

These hot summer days are biting into the day-job-quota as people pass out all over the place for the want of a drink of water or attention (or both). Then there’s piggie flu which, predictably, is making a mockery of the system by clogging it up with people who should really know better and who think they will die if they sneeze too hard. On top of all this, we still have leftover drunkards from the weekend nights and those who think a minor injury (if it happened at home they wouldn’t dream of dialling 999) in the workplace is somehow elevated to an emergency simply because it is the workplace – I call this backside-covering.

So the first call was a hoax; of course it was – the guy calls us from a phone box to say that he will jump in front of a train in the next 30 minutes. He is warning us of his impending suicide and giving us more than a generous slice of ORCON time to get to him and cuddle him before he settles his score with God. I am sent to ‘investigate’ and sit outside a row of anonymous red phone booths waiting for something to happen but nothing does. He isn’t there and the next report tells me that he is making his way to Piccadilly Circus to end it all, so I am tasked with standing by, along with a couple of PCSOs and the British Transport Police (BTP), at said station for the next hour until it becomes obvious to all, and at great expense to the tax payer, that he isn’t going to show.

My theory is that he is a forgetful person who left the phone box, with the intention of doing himself harm but was distracted by something along the route – possibly the tourist tat sold in one of the little shops in Piccadilly Circus. He then completely forgot his mission and was probably standing on a corner, eating an ice cream and enjoying the sun – thinking how wonderful life is, as he watched us all converge on the tube station as if some kind of emergency was about to happen. ‘Hmm…I wonder what that fuss is all about?’ he probably thought to himself, as he crunched through the one and only flake that was embedded in his over-priced soft whip ‘99’.

The other side of the spectrum for my next call and I am sitting with an elderly lady who had fallen off a low step and banged her head. The 84 year-old didn’t think it was an emergency and I had to agree. There were two cops with her and they were playing safe, which is fair enough. She had a few members of her family with her too and they were keen to get on with being tourists, so when the ambulance arrived, we checked her out thoroughly (she hadn’t been knocked out and had no serious medical conditions) and she went on her way, family in tow. It’s always refreshing to meet a patient who knows s/he isn’t dying and can recognise a minor injury a mile away. Her age meant that a proper check was useful but her generation is still a bit mystified when we worry about such trifling things.

A ‘collapse in doorway’ turned out to be nothing more than a sleeping vagrant. MOPS had panicked and assumed he was dead (obviously), ignoring the fact that he was wrapped up as if asleep, he was positioned (curled up) as if asleep and he was snoring in a doorway (as if asleep). But hey, don’t let me get all arrogant ‘cos we all know that it takes years and years of medical training to spot the difference between slumber and death.

Two PCSOs were chatting to him when I got there – the road was closed at the top, so I had to get out and walk – tsk! I asked him if he was ok and he said yes. ‘Do you need an ambulance?’, I ventured. ‘Erm, no’, he replied as if I had been let loose from a dodgy institution.

Now this poor sod had been trying to get a decent sleep – he is already on the street so can’t be getting a good kip during the busy, noisy nights. He puts his head down in a doorway of a weekend; not bothering anyone and not asking for attention, then ends up with PCSOs and a paramedic bugging him about his health and lifestyle. Not fair really. If you are a concerned MOP, please check for signs of life and the presence of a sleeping bag before you call us out.

I climbed so many stairs to get to a 21 year-old girl who had fainted in a theatre that I thought I might join her myself. She was on the floor, legs raised in traditional fashion, with her boyfriend guarding her. She works there and the heat just got to her, although she admitted having a history of such events and being a generally poorly person, so I walked her gently and slowly down Everest until we got to the car. Then I took her and her partner to hospital where, unfortunately, she was made to sit in the crowded, Swine-Flu infested waiting room until someone could get round to seeing her – probably 12 hours later.

Be safe.