Thursday, 16 July 2009

Risks

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.

5 comments:

Bertie Humbug's Ranto-O-Matic said...

She wasn't ill, she was vulnerable (because she's dumb)

Tom said...

If it was my daughter I would have 'skelped' her arse, and picked her up.

Hopefully my granddaughter will know better.

999 is for an emergency only.

Anonymous said...

Are you a PPED Stuart? I guess you must be if you have a Student Paramedic with you.....she's a lucky girl :) Hope I get someone with your expertise and experience! Although at this point I wish I even knew who mine was going to be :(

Regards
Maz - a SP about to go operational for the very first time!!!

Xf said...

Maz

Yes, I am a PPed. Got to keep my hours up though cos I work alone, so now taking on Student Paras. If you are LAS, ask your TO and see if they'll let you come out - you can get your hours in wherever and whenever you know.

Anonymous said...

Thanks Stuart I might do that once I go into my second year after October.....it would be great to get a different perspective in another area. I'll be in a sleepy suburb for the time being which is probably just as well :)
Maz