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.


Anonymous said...

top post, when your times up, its up.

JB102 said...

I understand what you say about first aid qualifications, but we do not even recognise them in control. We are told to never doubt the integrity of the caller and yet when they state they're a first aider we'll ignore them and tell them to do only what the scripts say. Purely because we do not trust them. Swallowed a corrosive liquid? No sips of water. Unconscious? On their back hold the head up and don't move. the list goes on. St john, red cross, we'll ignore you all!

Anonymous said...

thats why my colleagues had to ignore the call taker who told them not to move a casualty who was not breathing due to a large blood clot + blood pool he was lying face down in.stick to the script?it was a bicycle accident that mashed his face

Tom said...

Yet another night in the concrete jungle.

I recall my wife being sent to Reading for a first aid course. Bless her she was required to attend as it was company policy.

To this day she remembers the protocols, and only if absolutely necessary would she dial the three 9's.

Deirdre said...

Not just the professionals who ignore first aiders - daughter and friend, aged 18, had just completed and qualified on a course when they were behind a chap who collapsed. They checked him, as trained to do, started chest compressions on him, while their friend called 999. A man rushed out of a local shop and said he knew what to do, as he pushed them off the chap and started, ineffectively, giving mouth to mouth - as seen on the telly. Sadly the patient died shortly after arrival at hospital. The girls will never know if he would have survived if they had been brave enough to fight back.