Sunday, 15 November 2009

Ghost hospital

Night shift: Eight calls; two false alarms; one by car; the rest by ambulance.

Stats: 2 Head injuries; 1 ?PE; 1 ?Allergic reaction; 1 Sleeping non-fitter; 1 Homeless sleeper; 1 eTOH with fracture; 1 Abdo pain.

Radio communication is still leaving me in awkward and dangerous situations and being solo without a voice at the end of a call is beginning to look like a rotten option. My first call highlighted, once again, that our new all-bells-and-whistles radio system may not be as good as we are told because I found myself crouched down next to a semi-conscious man who’d sustained a head injury after hitting the ground hard, surrounded by drinkers from the pub outside which he’d come to grief, all denying that he’d been punched in the face when the evidence was clear that he had, and absolutely no reply to my repeated requests for assistance over the air. One of my MRU colleagues heard my open-channel request for the police and an ambulance and liaised on my behalf to get things organised as I attempted to keep control of an increasingly restless patient and a crowd of witnesses who ‘didn’t see anything’ in very close proximity to me as I worked to get obs.

The police arrived within few minutes as I put oxygen on and completed the minimal obs I could gain under the circumstances, then the MRU paramedic pulled up to add another pair of hands to the task.

I’d palpated the man’s neck and it felt like he had a step deformation (where the bone feels like it has sunken in) of his upper spine at the neck; this is not good and suggests a seriously hard landing on the ground when he fell, probably hitting the kerb with his neck. His mouth was bloodied and burst around the side (the first indication that I’d got of an assault and not a fall, as had been vehemently suggested) and he was slipping in and out of consciousness, although the alcohol he’d imbibed possibly had a lot to do with that.

HEMS was requested because the man needed to be calmed for the trip to hospital and his head injury would soon make him very difficult to manage safely, so the police threw a taped cordon around the scene and once the doctor arrived, the patient was RSI’d and rushed to Resus, with me ‘bagging’ him all the way there.

I'd find out later on that this man's condition was very serious indeed. He had multiple skull fractures with internal haemorrhaging to his brain and a broken neck.


A 23 year-old French girl fell down at work, complaining of leg pain, chest pain and feeling faint. She told me she had a history of ‘bad circulation’ in her legs and I thought that working as a waitress at a restaurant was possibly not a good move if this was the case. She may have been describing blood cots in her leg because the actual problem she suffered with was not clear. Certainly, and even in the absence of dyspnoea, there was reasonable cause to believe that she may have a PE and so I asked for an ambulance, rather than risk taking her in the car.


If we come to help your young child after you’ve called 999 and requested an emergency ambulance, please do not do the following; (1) expect us to assess him/her while he/she is still asleep in bed; (2) tell the paramedic who has just had to wake your potentially dying child up in order to do said assessment to ‘speak quietly’ so that he doesn’t wake your other child up (the one in the cot nearby) and (3) inform your child that the paramedic will be sticking a needle in you when he is about to do a BM test.

The parents had called us because mum thought her child was having an anaphylactic reaction in his sleep. The crew was arriving as I pulled up and we were led into a dark room in which two children slept peacefully. The boy in question had been breathing a little noisily so mum was concerned. He had a history of potential allergic reaction, so she was being careful and wanted us to check that he was okay but she didn’t want to wake him up and took issue with the volume at which I spoke to him when he was awake. She’d dialled 999 but was more concerned that I’d wake up the other sleeping child; it was a confusing paradox, so I suggested we take the boy into another room, where I could speak like a normal person and not a librarian.

‘What’s he allergic to’ I asked. ‘Horses’, mum replied. Bearing in mind we were in Central London and the nearest horse was probably rotating on a spit in the local kebab shop, I found it unlikely that her little cherub was reacting to one.

He was fine, except for a cough; there was no wheeze or swelling or rash or any other problem that I could determine – not that he was very good at co-operating; he wriggled and cried and was obviously too tired to be prodded about like this, so I decided a BM would be the last of my obs while I had the opportunity. Unfortunately mum decided it would be prudent to inform her little 4 year-old that I was about to stick a pin in him and, predictably he went a bit mad; writhing, screaming and generally making more fuss than it was worth. On this basis, I confirmed that he was well enough to stay home and abandoned the idea of taking a drop of blood from him. Mum seemed pleased. ‘It’s okay, she’d said to him, it’s just a little prick’. Yeah I thought... it is.


And then the local drunks had a laugh at our expense when a bus driver called in a ‘collapsed person’ that he’d seen fall down at a bus stop before driving off. What he had seen (and had generated a Red1 call) was a very drunk fool falling over. The guy was on his feet and swaying when I arrived. His grin and sheepish look made him the ideal culprit for someone who frightens citizens into doing the right thing. He stood with a black bin bag in his hand – it either contained his worldly goods or cans of extra strength lager (which amounts to the same thing). So, without actual proof and his denials ringing in my ear, this was a no-trace nonsense call.


A ‘fitting’ call in Oxford Street was nothing of the sort. The poor guy was trying to get his head down for the night in the doorway of a shop and had been rubbing his hands together to keep warm when two MOPs, one of which identified himself as a nurse ‘with a year’s training’ decided he was epileptic and having a seizure! So, when I arrived, the homeless man was understandably peeved and the ‘nurse’ continued to be concerned despite the fact that the man was very clearly not having a fit. ‘If I was having a fit, I would have told them’, he shouted illogically. The MOPs should have taken the hint but they didn’t and were keen to see me haul the man off for tests and such no doubt. ‘I’m being harassed now’, said the trying-to-sleep man.

After I’d politely sent the MOPs away, the homeless man told me that the ‘nurse’ had been feeling his leg and saying ‘come home with me’. Apparently one go wasn’t enough and the nurse-MOP had returned again and again after several objections from the man, allegedly to cop a feel and ask him back to his place. London just gets weirder and weirder.


On the second attempt at trying to put me on a rest break, I was called to attend a 75 year-old man who fell down a few steps at his apartment building and cracked his head on the floor. He’d been carrying a plastic bag containing two half bottles of whisky and these were now rattling about inside it, so his money and ambitions to get even more drunk than he already was, had evaporated.

Two of the tenants, returning from holiday, had come across him and his bleeding head as he lay around waiting for rescue. Luckily they had been returning from holiday at a rubbish hour of the morning and just happened to be entering the building at the right time to call for help. Otherwise he may well have been there til much later on in the day before being discovered.
His injury was minor – a cut or two to the top of his head and a slight bruise on his face but his age and the circumstances of his inebriated fall were worthy of a hospital trip.


As I sat on Trafalgar Square watching as workmen placed a bunch of strange trees onto platforms I got a call to a bus on the other side of the Square. There was an unconscious man on it apparently, shock horror. He was a tall, filthy, homeless chap with dreadlocked hair and huge laceless shoes. He was asleep and easily woken. Within 3 minutes he was off the bus. Then he crossed the road at a pace (he’d been limping as he left the bus) and boarded another bus going north. I watched him go upstairs, sit at the back (where he’d be invisible), pull his hood over his head and settle down for a sleep (part II). Somewhere in London later on an ambulance will be called just so that he can be ejected from the vehicle; he will bus-hop at the expense of the tax payer and genuinely ill people all night and probably every night.

Now, I wonder how he and his fellow bus-hopping homeless sleepers get aboard. Do they have bus passes? Doesn’t the driver recognise a potential problem when he or she sees it climb on? I’d really like to hear from bus drivers on this subject.

Of course, I complain about them but it’s the drunks on buses that annoy me, not so much the sleepers with nowhere else to go. I think I’d rather be called to wake them up than have them go to hospital to steal a warm bed and a free meal from a more deserving person (like someone who is unwell). In some respects they are playing the system where London Buses is concerned. If they are allowed on and can hide at the back without being bothered then they might get an hour to sleep at a time. Unfortunately, the bus people can’t manage this problem so we are called to deal with it and that is an abuse of the service. Street dwellers looking for a dry, warm place to sleep is nothing new and they will go anywhere that gives them an undisturbed kip – the buses are included, so why don’t the bus people fix their own problem? Maybe it’s best just to leave this status quo for the sake of the ‘they have to go somewhere’ argument or purely on humanitarian grounds but what if this costs someone their life?


This debate continues with a trip to a bus terminus to attend to an alcoholic whose been removed from a bus by the police. They think he needs to go to hospital and they are right because not only is he very cold (temp read ‘LO’) but he has a cast on his arm and from the appearance of his upper arm, just above the cast and sling, it looks to me as if he has broken his Humerus and dislocated his shoulder. This drunken man has fallen onto his already injured limb. So, I take him to hospital in the car and I walk into a ghost town – beds are empty and there is nothing going on. For the first time in a long time (as far as I can remember in fact) there are no ill or injured people around. Except of course for the one I’m bringing in. Judging by the reception I got you’d think I ruined someone’s birthday party. Even in the waiting area there was nobody waiting. This must mean that Londoners have drunk themselves to sleep or that alcohol has simply run out.

A local call to end the shift and a crew arrived behind me for the lady with abdominal pain who needed more advice than treatment. I left as the crew settled in to listening to her entire medical history. They had another 30 minutes to go, so I’m sure they didn’t mind.

Be safe.

8 comments:

Crystal Jigsaw said...

It's much quieter up here on the north coast! We hardly ever see a blue light (apart from the one which shone outside my place the other week waiting for me) but it's a mad dash to the window and a "I wonder who that's for" excitement.

I really enjoy your humour, if you ever feel like leaving London, I'm sure Northumberland could accommodate you.

CJ xx

Anonymous said...

Hi there

I'm a busdriver on a route in SW London and all I can say is: we have got our regulars too and you get to know them. There are always the same dark figures climbing on our 24/7 routes, drunk and looking for a warm place to have a nap and no, most of them don't have bus passes but what can we do? The alternative would be stopping the bus there and then, preventing all other passengers from getting home, and calling control which will inevitably call the old bill to attend for a fare dodger who (they know) will never be able to pay neither penalty fare nor any other fees, so what's the point?

Most of the time it is (as I am sure you do as well) taking the road of least resistence and getting on with a stressful, dangerous job (we get threatened and assaulted a lot).
It is NOT us drivers who call out you guys for a DOAB, we just follow procedures, i.e. if we arrive at the terminal stop and there is a non-responsive person still on the bus, we try to address them and waken them by shouting or banging the window next to them, which hardly ever works and what we do then is: call our control centre. Those are supervisors and indoor managers sitting in the warmth and all they can think of is calling the emergency services out as they cannot see the individual, neither do they want to put any staff member at risk of getting assaulted. Again, you probably think, we leave it to you to get assaulted, when really we don't have a choice and simply follow what we were told during training, we need to report these things to our control and THEY decide on what to do from an office somewhere in London!
I am really sorry you hate us so much for doing that, but our job is dangerous enough. It is not that we are NOT ALLOWED to touch people, it is simply following our instinct to avoid getting hurt and also, acting according to our protocol which states we have to report incidents like that to control staff.

I really like your blog and I think you do a great job.
I had a young woman running in front of my route master on the second day after qualifying a few years back and I remember HEMS turning up and saving her life while she was trapped UNDER the bus, they did a fantastic job, although I ended up needing counselling for blaming myself and feeling guilty. I never learned whether she survived or not and it took me a while to get over that experience. I am probably just too sensible.

Thanks for doing the job you do and all the best,

Susan

Anonymous said...

Xf,
When a RSi is carried out is this only for head injuries ?

Xf said...

CJ

Thanks for the invite. Maybe when London chucks me out, I might wander up that way :-)

Xf said...

Anon

Nope they anyone can be RSI'd but it's more likely to be used for head injuries like this.

Xf said...

Susan

First of all, thank you for taking the time to write in on behalf of bus drivers.

Secondly, I never ever said I hated you guys - I don't hate anyone to be honest. Read some of my older posts with regards to DOAB's, bus drivers and assaults because I know what you go through and ask any driver who has seen me; they will tell you I get on the bus, say hello, move the offending culprit, smile, chat and say goodbye. I always make a point of reassuring the driver and they know I warn them not to put themselves at risk.

I know your managers call us out; they are the ones abusing the system but, as you point out and as I have argued, what else can be done?

A private company could be formed to go and wake these people up. The bill could then be sent to London Buses. That would work I think.

As for you and your colleagues, you have tough enough job as it is, so you can always count on us to be there if needed.

Kristen (Las Vegas, USA) said...

I have been reading your blog for about two months (reading from newest to oldest; I'm some time in 2007 now), and I am now also in my 4th week of EMT classes. I think that reading so much of your experiences has actually given me a head start over a lot of my classmates. I'm familiar with the terms that are getting thrown around, I know what some typical and non-typical calls can look like, and best of all I've gotten to see and feel in detail how a medic approaches and analyzes a scene. It's really been invaluable, and I know that I'll probably get even more out of your writing as I continue my training.

Just wanted to say thanks and keep it up!

Anonymous said...

Bad radio comms - Not put you on Airwave I hope. You would be better with two tin cans and a bit of string!