Tuesday, 14 July 2009

Overbreathers

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.

9 comments:

living_with_ba said...

The asthmatic makes me mad...I am Brittle Asthmatic and am so scared to call 999 at times in case I'm wasting their time even when I can't talk in sentences, it's people like that who DO waste your time that make it hard for people like me...

Deborah Parr said...

I'm an SJA member and even we get the fallen-over drunks, the alchohol-fuelled fights, the catfights, the "Poor Little Me" types - and we don't feel much sympathy either. Or even any.

AJ said...

I'd get those bus numbers muddled up without the aid of alcohol. :)

It's ridiculous though, the amount of time and money that is wasted by people. And 9 times out of 10 these are the people that would go and cry to the tabloids if somebody they knew lay waiting for an ambulance because time wasters like them were clogging up the ambulances.

MarkUK said...

Any idea why the paper-bag method of stopping hyperventilation went out? It used to work very well.

Xf said...

MarkUk

Because there was no empirical evidence that this technique was any better or worse than simply calming them down. Also, paper bags were being given to asthmatics by mistake.

prudence entwhistle said...

About three years ago I was hit by two eggs thrown from a car - one on the shoulder and the other on the chin. It was surprisingly painful, and not particularly funny. Besides, one doesn't expect it.

Furthermore, it's a waste of good eggs.

Viking83 said...

Thanks Xf, I saw it went out in the new SJA manual, and I was wondering why. I find its a good 'placebo' sometimes because while it does nothing of value it makes the person your calming down feel like your doing something.
However, your piont about asthmatics getting a bag instead of O2 is a good point.

Anonymous said...

Some spot on points but I can't help feel theres a few sweeping statements in here...as a previous sufferer of panic attacks its a heck of a fright before you realise what it is so i can understand the odd over reaction however that said even in my scariest moments i never dared to phone an ambulance!...Comments about depression maybe a bit judgemental based on close to home experiences not everyone suffers such due to looking for more attention, traumatic life experiences can cause episodes, the writer would be better reminded nearly everyone suffers depression at some time and am sure they wouldnt like themselves described as this.

Xf said...

anonymous

As I pointed out at the very beginning of the story - I acknowledge the problem. The point being made is that it is NOT our emergency and therefore someone else needs to look at this and deal with it while we get on with treating physical illnesses.