Thursday, 30 April 2009

We're all going to die!!

Day shift: Five calls; one sent home; one dead at scene; 2 conveyed and one by ambulance..

Stats: 1 Sprain; 1 Fall; 1 ? Swine Flu; 1 Purple plus; 1 Sickle cell crisis.


‘Keep away from me’, he squealed, ‘I’ll jump. I mean it. I’m a pig on the edge!’

I moved cautiously towards my little porcine patient but he was nervous and his runny snout and occasional sneeze made me just as apprehensive. Could I save him? I didn’t know. The whole world was against him and his kind, so would it be worth it, I wondered.

Then he fell; jumped to his death in front of my eyes. The last thing I saw was his pink eyes disappearing over the precipice of this tall building known only as ‘The Pen’. I felt sorry for him but at the same time, relieved that I didn’t have to justify myself to the Press and waiting health officials below. They’d seen it too and they were glad. The roar of approval from them still rings in my ears.

Have you had a pig-related nightmare yet? Are you worried about the effect this latest world crisis is having on your children?

For God’s sake, its only ‘flu! The Mexicans showed balls when they tried to contain it and now their entire nation has been tarred and feathered. Their economy will suffer enormously because of the decline in tourism alone. And the poor pigs (they are very clean you know) will probably all be slaughtered.


Luckily for me the first call of the day was to a 60 year-old woman who slipped on some steps and sprained her ankle. She vomited in the street because of the pain but when I arrived to take over from my MRU colleague she was recovering from the stumble and was able to climb in the car with her man-friend and allow me to take her to A&E.


Then I met a cheeky little 11 year-old girl who fell at school and was knocked out for a while. She was sitting outside the school office when I got there. Another MRU colleague was attending to her; I’d followed him after we’d both received the call at the same time while chatting outside our usual haunt, Bar Italia on Frith Street (it’s a coffee house, not a pub). I watched as he nearly took a tumble himself when his motorcycle slipped on spilled diesel in the road. I worry about them, I really do.

Anyway, she was fine now. A bump to the head and a very worried mother was all she had to show for her mishap. By all accounts, she’s historically famous for this kind of thing, having broken her bones before in the past.

She sat in the back of the car with her mum and chatted away and I told her that they were ignoring me on the radio after I’d attempted to get the call in to say I was taking her to hospital. I told her that they often did that and I appealed to her for sympathy. I waited for a few seconds to see if she would agree that it was truly disgusting and that I deserve more respect than that but I got a one-liner and my feigned hurt was squished immediately. ‘My heart bleeds for you’ she said.


Now I’m asked to go and check out a man whose been ‘detained’ (can’t think of a better word) at a train station because he’s been back from Cancun in Mexico for a few days and has fallen ill; runny nose, headache, aching limbs and generally unwell. Nobody else has been sent so I wander in and find him sitting on a chair, away from passing passengers, as if he's carrying a Hollywood disaster virus.

I check him out, ask him questions and he gives me answers. His wife is also ill and she too had been to Mexico. His daughter had also travelled with them but she, as yet, has shown no symptoms. Since coming back they have both been travelling the country on business, so if they have it, they are spreading it.

All seemed normal with him in terms of his vital signs – he didn’t have a temperature and I advised him to go home and see his GP as soon as possible – we certainly aren’t taking people with Swine Flu into busy A&E departments and the symptoms are mild, so like all common influenzas, we are giving them general advice. I know you may want to lecture me about the deaths that have occurred but they have been relatively rare and even the Mexican Government admits some of the reported incidences may have been down to another illness entirely (and coincidentally).

I wasn’t going to make this a drama and I refuse to be drawn into the paranoia that has been irresponsibly stirred up. I blame the Press for the death of my piggy friend.

So, the man’s vital signs are normal but he is very, very agitated and nervous. I complete my paperwork and he goes to catch a taxi (homeward-bound I assume). I report the incident, as is expected and I find out that almost every piece of personal information he has given me is false. We can’t trace his postcode, phone number or GP details.

A police officer approches me afterwards and is visibly shok=cked to learnt that I had 'released' him into the general populace. I explain that it is only a mild viral infection so far and that we aren't going to alarm everyone. That didn't stop his face from dropping in horror before he told me that the staff at the station were now very concerned about their health and welfare.

I went back to my station a little concerned at what my patient had done – he was an expensively-suited professional legal person, so I was perturbed that he’d lie to me. I think I might have developed phantom symptoms because I sniffled a lot after meeting him.


I was diverted from a RTC involving a patient with a fractured femur (MRU on scene) to a cardiac arrest and arrived to see that two crews were on scene. I went up the stairs to the top flat and there, on the floor, was the body of a 38 year-old woman. She was dead and had been for some time, so CPR wasn’t initiated. She was a nurse and there was a syringe attached to a well-secured cannula sticking out of her foot. It looked like she’d set this up and injected herself with something – probably something she’d been able to get from work. Something lethal.

There wasn’t much else to do except call it, time it and get the police in. Her boyfriend had discovered her and he was very confused about the syringe.


A late job south of the river and a 20 year-old girl with Sickle Cell was suffering a crisis. She managed to get to a friend’s house and now she was kneeling on the floor in agony. I gave her entonox (good in the short term) and the crew arrived a few minutes into my treatment, so I was free to return to base.


If this ‘pandemic’ continues, we are going to become extremely busy with people who have a mild illness. At this stage, only the very vulnerable will be in danger, so I think we need to shift our focus onto the elderly, those with immune system deficiencies and small children. Clearing entire schools and locking them down with police sentries at the door is way too over the top at this stage. They don't do that when kids have bacterial infections and wander about the school playground coughing and sneezing more virulent germs about, do they? No, they even let them attend school whilst still on antibiotics, so therefore still possibly infectious.

The difference is publicity. If the Press wanted to ensure a real crisis, they could easily invent other possible sources for the infection and most people would fall for it. If you eat a fajita you'll get it; if you speak Spanish you'll get it; if you wear one of those large floppy hats (Western stereotyping) or go for siestas you've definitely got it....see what I mean?

Be safe.

Wednesday, 29 April 2009

Paranoid Pandemic

The media love this, don't they? Anything to stir up a mass panic, sell newspapers and generally quieten us all down about the rubbish state of the world economy.


Day shift: Six calls; One assisted-only, three conveyed, two by ambulance.

Stats: 1 Leg pain; 1 Fall; 1 Flu; 2 Abdo pain; 1 D&V.


The Swine Flu uproar hit London today and, predictably, calls were starting to come in from people who were convinced they had it.


A call to a man with leg pain first and I was off to a third floor flat in the expectation that this was a non-emergency and that he would be walking/hopping to the car. It was a Green call and I was surprised that they’d bothered to send me on it because we were busy today and this could have waited.

I walked into the flat and was ushered into a small bedroom where the patient lay on the floor. I knew instantly that he wouldn’t be coming in the car and that an ambulance would be required. Had my instincts told me that he was seriously ill? Had his critical condition made it clear to me that conveying him by car would be dangerous?

Nope. The man had no legs.

Well, he had two stumps and a couple of prosthetic limbs that he couldn’t attach or use because he was in too much pain.

He was from Iraq and I found out that he had been a soldier during the first Gulf War and had lost both legs during that conflict. Now he was in pain, probably caused by inflammation around his stumps. He’d suffered this before but now it was worse than ever. I gave him entonox and that helped a little and my request for an ambulance was acknowledged but I waited an hour with him because the first crew was diverted to a higher category call (predictably).

After the long delay, during which I attempted to keep his pain at bay with gas and air, a crew arrived and I finally got the assistance I needed to get the man downstairs and on the way to hospital.


The next call was a long way off and another Green category that could have waited. It took me almost an hour to get to the 95 year-old woman who’d fallen onto the floor and couldn’t get up. Other calls were coming in but I continued to trundle along until I got to the house. I went in, lifted her from the floor, put her back in her chair and then watched as she walked, unaided, into the living room. I had been greeted with ‘just get me up’ as soon as I’d said hello.


My first patient with delusions of Pig Flu was in her sitting room waiting for me when I arrived at the posh block of flats in Central London. ‘Have I got it?’ she asked as she trembled and fidgeted nervously. She had a headache, achy joints and sinusitis, so obviously she’d jumped to the conclusion that her illness was of Mexican origin.

I tried to persuade her to stay at home and recover but she became upset about the prospect of being alone with what she thought was a deadly virus. Despite the fact that I was sitting two feet away from her and pointed out that I was breathing the same air, she remained true to her paranoia. I called her GP - a Harley Street medic – but he was singularly disinterested, especially when I gave the patient’s name – he obviously knew her well. ‘If she hasn’t been to Mexico then it is impossible for her to catch it’, he told me in a self-assured fashion. I had to disagree with him on that matter simply because it annoyed me that he’d be so arrogant as to assume it wouldn’t become a person-to-person infection – the next few days were to prove him wrong.

'Would you like a tea or coffee?', she asked as she wandered into the kitchen. She wanted me to stay with her I think but I managed to get her to make her mind up - either we get this illness dealt with now in hosiptal or she waits at home (and gets better). 'Okay, I'll go', she said. then she insisted that I take a couple of buns from her - they were in an opened packet - two of them had already been scoffed. I was getting the leftovers but she was trying to be nice, so I took them and they stayed at my station until somebody ate them. Not me, I should point out.

I took the patient to hospital against my better judgment and she resisted that too (even though that is precisely what she’d wanted). Now she was afraid that she might catch the dreaded flu from others in A&E! There’s was no winning with her and she sat in the department waiting room with a handkerchief over her mouth and nose, much to the amusement of the masses gathering there.


The first abdominal pain; a 22 year-old woman at work who made her colleagues call an ambulance, cured miraculously on the way to hospital in the car. As long as her friends and colleagues were around, she was doubled up in pain and quite unable to walk properly but when she was in the back seat of the car with a male friend, she was animated, chatty and made several pain-free phone calls on her mobile. An interesting study will come from such behaviour I think.


I risked the car seats (which are adequately covered) for a 26 year-old vomiting female who’d attempted to get home from work when she started feeling unwell but didn’t make it, getting no further than the underground station. She was constantly being sick and her own diagnosis was that she’d eaten something with wheat in it. She had intolerance to the stuff and suspected she’d inadvertently absorbed some in her food earlier on. Whatever it was, it was giving her the usual double-whammy of Diarrhoea and vomiting (D&V). She carried a suspect plastic container inside which had been a salad that she'd eaten too – it didn’t smell healthy, so I don't think wheat was the problem.


And finally – a 39 year-old woman with ‘chest pains’ turned out to be my second abdo pain (some people just can’t tell the anatomical difference). A crew was on scene, so I left it with them and sped away towards the lights of base and, eventually, home.

Be safe.

Sunday, 26 April 2009

Runners

Day shift: Four calls; One assisted-only, one conveyed, one gone before arrival and one by ambulance.

Stats: 1 Allergic reaction; 1 Faint; 1 Collapse.


The day of the London Marathon was initially quiet for those of us who were covering the ‘rear lines’. I couldn’t volunteer to cover it this year because my rota meant I was on an early shift today anyway, so I spent the first half of the day either at the station watching it on television with my MRU colleagues, or out and about – where very little was going on.

All that changed in the afternoon when the runners began to arrive at the finish line on The Mall. Now that thousands of people had piled into Central London and hundreds of runners were feeling the strain of their efforts, things got busy instantly.

The first call, to a 28 year-old woman having ‘a fit’ turned out to be an allergic reaction – a very mild one too, with a widespread erythemic rash and itching. The restaurant had called an ambulance and given it as fitting, even though it was patently obvious, even to an untrained eye that she was not.

The crew was on scene at the same time as me and they took her away to hospital for further treatment (antihistamines).


The first of the runners to come to my attention was a 52 year-old man who collapsed in the street. He was helped into the recovery position by other runners who were nearby (all MOPS were medal-donning, shorts-wearing individuals today). By the time I got to him (the traffic was now becoming incredibly bad) he was well on the mend after what seemed to have been nothing more than a faint brought on by exhaustion and a lack of salt.

He insisted he didn’t need to go to hospital and I gave him a lift to the street where he was meeting his wife. He had initially been very pale but now his colour was returning and he was much better, so I got him to sign my get-out-of-jail form and handed him over to his wife. He attempted to explain to her why he was arriving by ambulance but she seemed unimpressed and simply said ‘But you finished, right?’


The next collapse was a 43 year-old man who, at first sight, looked like a woman to me. He was sitting at a table outside a cafe, drinking water and slumping in his chair. Others had called an ambulance for him because they were concerned. It was his fourth Marathon but he’d never felt like this before – he was weak, nauseous and dizzy. His skin, like the last runner’s, was caked in little clumps of salt, drawn out of his body with sweat. He was dehydrated.

He stood up as I helped him walk to the car and I noticed he was wearing a tutu. Maybe he’d run in costume, I thought. When we got to hospital and I popped my head around the cubicle curtain to hand in his paperwork, he was in the middle of getting undressed and I knew then that his attire was part of his life-style – he was unhooking his bra.


The last call of the day – all four had come in quick succession, making the shift feel busy even though it wasn’t in terms of job number (for me anyway) – was to an 83 year-old man who’d fallen on escalators at a train station. I drove the long way round because of road closures and got there to find that he’d left long before. He’d decided to go home after waiting almost an hour for an ambulance.

Be safe.

Saturday, 25 April 2009

People can change

This is Edwin Linton. I met him on Trafalgar Square as he drummed up sponsorship for his forthcoming Marathon run in support of St. Vincent de Paul for the homeless at the Spanish Church in Marylebone. He's a born-again person who almost died of TB when he was an alcoholic. Now he helps others in the same situation.

Edwin is also an artist. His work can be seen at http://www.theothersidegallery.org - find him in the gallery section.

Day shift: Seven calls; one assisted-only, one conveyed and five by ambulance.

Stats: 1 Leg injury; 1 Chest pain; 1 EP fit; 1 DOAB; 1 Head injury; 1 Mental Health; 1 Abdo pain.

There was a St. George’s Day concert on in Trafalgar Square today; it’s the first time I’ve seen the English openly celebrate their national day without hiding away for fear of racist taunts. It’s a shame that the country I live and work in (and therefore has fed and sheltered me) seemingly cannot display nationalism without coming under attack by politically-correct purists. Unfortunately, I didn’t see a single St. George's flag flying – the only crosses worn were on capes wrapped around English (and non-English) shoulders.

At the same time a juggler entertained the crowd up top and an anti-disappearance group (against missing people I guess) tried to campaign right next to him. This had the surreal effect of producing a very serious looking group of people with real-life (and equally serious) issues whose chants across the square were apparently met by squeals of laughter and applause as the large crowd close-by showed appreciation for the juggler. It just goes to show; you’ve got to pick your soap-box position properly.


Back on the FRU but only one conveyed. I needed an ambulance for a 71 year-old lady who slipped between an underground train and the platform, shearing the skin from her shin in the process. There had been a decent amount of bleeding before I got on scene and a light dressing had been placed by the staff. I had a look at the injury and it was still dribbling a bit of blood, so a larger, more compressed dressing was put on it.

I have to point out that the London Underground first aiders know that we will want to have a look at an injury and so they tend to put a lightly tied dressing in place unless bleeding cannot be controlled. We appreciate that and replacing it with a better one is not a slight on their first aid skills in the least – they know that and now, so do you.


I also needed a ‘truck’ for my next patient, a 31 year-old cocaine user with chest pain. He’d been off the stuff for months but hit a bout of depression and took 5g overnight to placate himself. A smaller amount would probably have been enough but his heart wasn’t happy with the load and so now he was in trouble. I waited with him as he continually apologised for ‘wasting time’ and the crew arrived soon enough to take him away.

He was a nice enough guy, just a bit misguided and obviously upset about something. His massive collection of DVDs was explained when he told us he was a professional film director. Outside his flat, as he was being wheeled away, a neighbour popped her head out the door and asked me if he was okay. ‘Yes’, I said in a non-committed way. She was in a wheelchair and had a bag of rubbish to throw out, so I offered to take it downstairs and outside for her. I am a gentleman after all….


Whenever I have recently requested police help I have ended up with more than I needed and a fairly over-the-top response. I was holding an epileptic down with the help of others on scene (MOPS) and I needed traffic and crowd control because he was lying in the road and there was a bit of a crowd gathering on the pavement, generally getting in the way. Somehow my request translated into ‘medic being assaulted’ or something like that and I got two police units, including an armed response unit. Two ambulances were also sent. By the time they all arrived, the epileptic had calmed down and wasn’t thrashing so much and the crowd had got bored and wandered away. Now there were six or eight people on the pavement. I had more backup than that!


The week wouldn’t quite be the same without at least one drunk on a bus (DOAB) and I got one with a bandaged hand and bad attitude when I went to the back seat to wake him up. His slumber was deep but no match for my determination to get on with my day, so after a few attempts at relapse he submitted and walked off…just as a crew was turning up.

His trousers were soaking wet and he was obviously lost. ‘I want to go to Haringey’, he told us. He was on the wrong bus, heading in the wrong direction and now he was staggering towards the wrong underground station like a child.


A 79 year-old woman with no previous medical history of significance fell and bumped her head in an art gallery. The injury was minor but during my obs I discovered a very slow and irregular pulse, so I asked for an ambulance so that an ECG could be carried out in an appropriate environment.

When the crew arrived she had already been walked out to fresh air by request and I had sat her down in the car for a while. Her ECG showed slow AF.


South to a bus station where a 39 year-old schizophrenic man who hadn’t been taking his meds was feeling ‘wound up’. The police were on scene with him and because he had nowhere to live, except the streets, I arranged for an ambulance to take him to hospital – he was far to agitated to ride in the car.


Sometimes the trip to hospital can cure illness – as was the case with my 23 year-old French patient who had called an ambulance from work after suffering abdominal pains. When I arrived she was doubled up in pain and could barely speak; her friend had to do the talking for her but when I got her into the car and away from her colleagues, she brightened up, talked a lot and beamed a smile every now and then. Funny that.

Be safe.

Thursday, 23 April 2009

Phantom pregnancy

Day shift: Eight calls; all by ambulance.

Stats: 1 PV bleed; 1 Knee injury; 1 Head injury; 1 eTOH; 1 Asthma; 1 Shoulder injury; 1 Sprain; 1 Headache with high temperature.

Ambulance work again and crewed with Allan on overtime. The first call turned out to be most strange. A 27 year-old woman with a PV bleed called us and, according to the description given, was eight months pregnant. This changed as we arrived to ‘not sure if she’s pregnant or not’, throwing a spanner our way.

She was in her hotel room waiting for us and when I asked her about the anomalous message she told me that she’d been raped eight months ago whilst on a business trip to London. ‘It was my fault for walking about so late at night’, she said.

Now she had a slight bleed and a noticeable bump on her abdomen – as far as I was concerned she was definitely pregnant but she still maintained that she didn’t know for sure and that she’d been treating her bouts of sickness and other signs throughout as general illness.

‘Haven’t you noticed anything moving inside there?’ I asked her as we made our way to hospital.

‘Yes but I thought it might be just wind’, she replied.

At no point did she display any emotion about this predicament and I don’t think I’ve ever met anyone in such depth of denial before. Still, I could be wrong.

At hospital, they confirmed what was so obvious. She was approximately eight months pregnant and now she’d have to face this alone. I felt so sorry for her - she actually believed it was her own fault. I hope she sorts it out in her head before the child becomes a victim of her terrible ordeal.

Nobody had been told this until she told me and now it was out I hope the police get involved and find the man who ruined her life.


Next, a female who fell while going up some nasty concrete stairs in a bank. The woman stumbled as she climbed them and damaged her knee. I found her sitting near the bottom of the steps with bank staff in attendance. Her pain was obvious but she put a brave face on it as she hopped out to the ambulance. Once inside, she was chatty enough with me but her knee was doing a ‘swell-while-u-watch’ and it became more uncomfortable for her as time passed during the journey.

She’s an ex-model, although she still dabbles, she told me, so I decided her knee was probably of some value to her.


A 27 year-old female fell from her bicycle, grazing her head, elbow and abdomen. She was still on the road with a helpful MOP when we arrived and began to fill up with tears after we’d left her at hospital. I guess the incident, albeit minor, had hit home.


A few people thought the man they found collapsed in a park full of sun-worshipping mid-morning snacksters was dying; there was a lot of red liquid around his body and he seemed to be unconscious. The police were on scene when we arrived and the ‘dead’ man was sitting on a bench trying to communicate with them. He was a Hungarian homeless alcoholic and the red liquid turned out to be red wine – the cause of his less than conscious state.

All the way to hospital he reminded me that he had two ‘broken shoulders’ but I made no sense of that and neither did anyone in A&E. I think his supposed injuries formed the basis of every 999 call, ensuring a bed and meal.


Oxford Street was closed off at one end as the LFB investigated a possible gas leak. An ambulance and a few other resources had been called but we were heading through the danger zone and into Regent Street to help a 20 year-old who had suffered an asthma attack. She was being treated by one of the crew from the incident ambulance and I freed him up and took over care of the patient.

She was a pleasant girl with a strange northern accent, which I tried to emulate when she was feeling better and smiling more. 'You're from Yaark?', I said when she gave me her address. I didn’t feel at all ‘racist’ because I’m from further north than her and have an even weirder accent. It helped her get through the worst of her asthma – which she said was more acute than ever before. I wondered if the gas leak, if there was one – had anything to do with it.


A minor RTC next and a 25 year-old man was knocked off his moped by a white van as he tried to pull an undertaking stunt near a main road. He suffered abrasions and a shoulder injury as a result. He also had a nasty puncture wound in his leg which had been caused by a small stone tunnelling into it when he fell. That’s what you get when you wear shorts on a moped.


Another dancer with an injury and we found ourselves in the company of a mad 18 year-old Norwegian girl who had dislocated her hip while warming up (or down). It had popped out and gone back in again, so she was in quite a bit of pain. I gave her entonox and she became a giggling maniac – highly amusing and entertaining I can tell you. She attempted to teach me Norwegian and I failed miserably until I got one simple phrase right – she’d said it to me and her friend translated ‘You are cool’. Well, I have to take that compliment because I don’t get many these days.


A late job, given to us within a few metres of the station and a few minutes from finishing had us travelling miles away for a 31 year-old woman with a headache and a high temperature.

She was at home with her husband and a FRU medic was on scene. I took the patient's temperature and it was 40.2c. She’d been ill since having a baby recently but had been told that her headache would ‘go away’ eventually. It didn’t and she was burning up. Her BP was also all over the place, so we blued her in and she went straight into Resus. It was one of those ‘should I, should I not’ calls but the doctor agreed that she needed to be seen immediately.

All in all, a good day and plenty of nice people to pass the time with.

Be safe.

Thursday, 16 April 2009

Infectious

Day shift: Five calls; all by ambulance.

Stats: 1 Mental Health; 1 Cardiac arrest; 1 DIB; 1 D&V; 1 TB.

Another ambulance shift and my crew mate today was Allan. For the third time in succession we found ourselves with a suspended call. Obviously when we work together people stop breathing.


A screaming 57 year-old psychiatric patient who was on police bail decided he couldn’t move his legs and cops were called to his flat because the neighbours were frightened and concerned by the noise he was making. We went in and found him on a chair in his front room. He complained of having ‘fluid on his face’ and we managed to get him to walk down the stairs to the ambulance unaided, despite his ‘can’t move my legs’ claim.

Throughout the journey he lamented his discomfort and I carried out a FAST check to be sure that nothing was being missed. Although his behaviour was strange and he seemed to have nothing wrong with him apart from a known psychiatric history, I wanted to cover all my bases in case he actually did have a problem. The arm drift check was nonsensical because he deliberately threw both arms down to show me how weak they were.


The cardiac arrest occurred at a hotel. A 25 year-old man had been found not breathing in bed by his 14 year-old sister. Both were visiting London from Ireland and she was sitting on the edge of her bed as the MRU paramedic, who’d arrived first, resuscitated her older sibling on the floor. She had an air of calm about her that shocked me (and everyone else).

As we worked on him, I asked her what had happened and she told me he’d been making strange noises in his sleep, so she’d turned him over to help his breathing. Then, a few hours later when she woke up, she found that he wasn’t breathing at all, so called an ambulance.

After eight minutes of frantic effort (he had been asystolic throughout), we got an output and shortly after that he began to breathe on his own. His diminutive sister had been removed from the room and I’d asked for a WPC to take care of her. She didn’t yet know that we’d saved her brother’s life.

Once we had everything in place and he was stable enough to be moved, we got him down stairs and out of the hotel. I spoke to his sister and told her what was happening but, again, there was no emotion. She behaved as if this was normal.

At hospital (I travelled with the patient and the MRU paramedic; Allan took the girl in our ambulance) I discovered that this wasn’t the first time he’d almost died. I’d already figured out that he must have come in drunk the night before – I can only assume he left his sister at the hotel as he went clubbing (he had an ink stamp on his hand). Then he’d gone to sleep and lost control of his tongue, thus the noisy breathing in the night. He’d vomited and inhaled it, causing his cardiac arrest. Shockingly, the girl told me (and the police) that he’d been taken to hospital a few years before because he’d stopped breathing as the result of aspirating vomit after a boozy night out.

Clearly, he hadn’t learned anything and his parents, who’d been told on the phone what was happening, still trusted him to take care of their young daughter in a strange city without their supervision. Crazy.


An electrical failure on our ambulance brought us to a standstill for a few hours as we swapped vehicles and equipment, and then we were off to a DIB given as a '73 year-old, drinking lots of water – sleepy'. Initially, as the call was coming in, the descriptor read ‘drinking lots, sleepy’ and I thought someone was surely joking because it was a Red call but we arrived to find the lady struggling to breathe, with sats of 56%, swollen ankles and fluid on her lungs. I gave her GTN, a nebuliser and Frusemide and this improved her condition within minutes. We ‘blued’ her in with better sats – not perfect, but better.


Sometimes you wonder if the blue call you made was perhaps bad judgement. It can be embarrassing to cause the fuss only to find that your patient really isn’t as bad as you thought, so the next call for a 43 year-old lady with diarrhoea and vomiting gave me the option of trundling it in or racing it in. I chose racing because when we got there her BP wasn’t behaving; rising then falling all the time. She complained of jaw pain on one side and she’d fainted earlier on. It all seemed a little more difficult to treat than D&V, although I couldn’t yet see a connection.

I had Allan call it in and arrived at resus feeling a little sheepish. I justified my decision with her medical history of hypertension, the fact that she looked very ill, her son’s concern that she’d ‘never been this bad’ and that unstable blood pressure of hers. In the end she was kept there because her BP plummeted soon after we arrived and nobody could figure it out.


Calls to potentially infectious patients are normally given to us with a warning to take proper precautions, which we normally do if we are made aware of them anyway. A call to a 43 year-old man at one of London’s grubbiest hostels, came with a notice that we were to wear masks. The patient had Tuberculosis and was running a temperature.

We didn’t have any face masks on board so planned to play it by ear when we got there but our arrival caused confusion with the staff, who knew nothing of this diagnosis. Now they were at risk.

The man sat in his little bed-sit and denied telling anyone he had TB. In fact he denied calling an ambulance in the first place. The staff member who met us said she wanted rid of him because they couldn’t cope with him but I didn’t see how that was our problem to be honest and I felt that they were using the ambulance service as a means of removing difficult customers.

We took him to hospital anyway – he did have a bit of a temperature – and during the trip I read his paperwork, which had only been given to me when I’d requested it before we set off. I found a note from a specialist communicable diseases department. The man was being investigated for TB after a lung x-ray had revealed abnormalities. Great; now we were back to square one.

The man continued to deny having any health problems, even when I read the letter out to him. A staff member was travelling with us and he had no knowledge of this problem. The fact that the man may have TB should have been highlighted to anyone who was in contact with him. He had a little cough – nothing serious but enough to throw spray around – so I put an oxygen mask on his face until we got to hospital, where a proper face mask was given to him after the nurse, who’d been told the story before I took him inside, decided he was too high a risk.

I went home feeling let down. Someone hadn’t given us the whole story and I still don’t know if I’ve been exposed to TB or not. I’ll find out when I get sick no doubt.

Be safe.

Wednesday, 15 April 2009

Phantom family

Day shift: Seven calls; all by ambulance.

Stats: 1 Unwell adult; 1 Chest pain; 1 Back pain; 1 RTC; 1 Head injury and ? fracture; 1 Seizure; 1 Suicidal.

I worked on an ambulance today and my crew mate was a friend from my own little station. The day was eventful but fairly routine.


Being pregnant may cause side effects. My first patient today, a 32 year-old who claimed she couldn’t eat or walk and was dizzy made a dramatic attempt to increase the speed at which she could be delivered care when she discovered she’d be waiting for a few hours with everyone else at hospital because her condition was simply connected to being pregnant. She wobbled on her legs and cried out that she was ‘feeling bad’ when the nurse directed her to the reception area of A&E, rather than put her straight into a cubicle for treatment.


At a train station, not far from the local hospital, a 79 year-old woman developed chest pain as she pulled her cases along the concourse on her way to the train. An ECG confirmed Left Bundle Branch Block (LBBB) and we took her directly to the Cath Lab, where an occlusion in one of her coronary arteries was found. She had no previous history and her angina had given us the opportunity to save her from something more dramatic and possibly life-threatening later on.


Then a strange story from a man with back pain. He twisted the muscles in his lower back as he attempted to avoid a car which was allegedly trying to run him over in the street. Apparently, the driver chased him in an attempt to cause harm – the reason for this eluded the patient. It might have been a case of road rage but trying to mow a pedestrian down because he or she has annoyed you isn’t the done thing. It’s illegal I think.

After the confrontation he went home but his back began to give him problems and so we were called to take him to hospital. While we were there a taxi driver ran into A&E asking for help. He had a passenger on board who was having a TIA. I went to assist and the poor lady was slumped on the floor. This was her third TIA in as many months and she was taken into Resus for investigation.


A slightly over-the-top response for an elderly man who was hit by a motorcyclist in the West End next. The man lay on the ground with a head and leg injury as two MRU’s, two ambulances and one FRU descended upon him. A training crew was left to deal with it – the man wasn’t badly hurt and the crew needed the practice.


Fractures to the Humerus are potentially limb-threatening, given that it is a large bone and contains major blood vessels and nerves, so our 65 year-old patient, who’d fallen and crashed into a wall on the way down was treated with great care. She had a minor head injury but it was the arm that caused most concern to me. ‘It feels like its floating’ she said as she described it to me.

Although there was no obvious sign of a break in the upper arm, the way she was holding it, the manner in which she fell and her floating arm description made it very possible that she’d seriously damaged it.


Myoclonic seizures consist of muscular twitching and rigidity – there is no full-blown clonic-tonic event but it is still a type of fit nonetheless. A 45 year-old man who was attending an out-patient clinic for HIV patients lay on the bed in the medical room, refusing to speak and sporadically jerking his upper limbs as if he had no control over them. He had no history of seizures but he was a Methadone user and its likely he was withdrawing. He wouldn’t confirm or deny anything and it took us a long time to get him to come with us to hospital.

On the way into the ambulance he had another event; stiffening up then jerking violently, mainly in the upper torso. The hospital was just behind the medical centre, so it took us a minute or so to get him into A&E for checks. He still wouldn’t talk to anyone and the doctor was left attempting to get the same information that I had tried to obtain. There were clearly other issues here.


The last call of the shift was to a 45 year-old male who had called from a phone box threatening suicide. He then told the call-taker that he had a knife, so we were asked to be careful.

The police were already on scene when we arrived and were struggling with him as he was dragged from the box and forced to the ground. A quick search of him and the phone box revealed that he had no weapon on him. The cops had received the call initially because drivers had been swerving to avoid him as he ran into the busy road nearby.

‘My wife and kids have died and you lot don’t care’, he shouted as the police restrained him and we all pondered what to do with him. He is a known paranoid schitzophrenic and had no physical illness, so no need for hospital but the police were reluctant to take him and I tried to think of a plan. None of the local psychiatric units would have him, so, after about an hour of his ranting, swearing and threatening, I agreed to take him to hospital and try to persuade the doctors that he was a danger to himself – thus a place of safety was appropriate.

When we got to hospital (with a couple of cops on board), the A&E staff were, understandably, confused about why he was there but I managed to get them to see our side of it and they accepted him.

He was still going on about his lost wife and kids and how the world didn’t seem to care about his troubles as I booked him in. During that process I discovered that he wasn’t married and had no kids.

Be safe.

Tuesday, 14 April 2009

DIY throttling

Day shift: Seven calls; six by car; one by ambulance.

Stats: 2 Dislocations; 1 Unwell adult; 1 D&V; 1 Back pain; 1 BPV; 1 Vomiting.

Sorry again for being a little behind on the writing. I am trying to catch up now so expect a few posts in the next day or two. I've been teaching recently and the last school I visited (in Gloucester) was one of the nicest I've been to. A beautiful setting for it and the staff were so friendly and welcoming. That's not to say that other schools I've been to aren't great but there was something special about this little lot - they all got on and you could tell they loved their place of work. The kids must be happy. Oh, and thanks to fidgeting Gina for the coffee :-)

A 31 year-old rugby-playing banker-cyclist fell off his bike, dislocating his shoulder and one of his fingers. He sat on a small wall with a police officer until I arrived. He didn’t complain once, despite the fact that he was in pain. He told me he was used to this kind of injury and we chatted about the banking world (and how I hate it) and the current crisis as I drove him south of the river to hospital.

My handover to the nursing staff was semi-absorbed because the ladies couldn’t take their eyes off this six foot and extremely well toned man. He probably got special care and attention when I left. He also probably forgot to tell his bosses (he works for the bank I'm with) to get off my back.


I called an ambulance in for my next patient, a 94 year-old man with a high BP, low BM and hypothermia (the probe simply read ‘LO’). He didn’t want to go to hospital and his on-scene carer couldn’t persuade him, so I hoped the crew would have better luck because leaving him at home alone wouldn’t be an option; not that we could have forced him to go of course.

He’d been found in his armchair with everything strewn around the floor, as if he’d fallen and dragged himself back up. His ankles were very swollen and his breathing wasn’t too great. Even when he tried to convince us that he could move around he failed because he couldn’t get himself out of the chair.

Luckily the male-female crew managed to change his mind (I think the female had more to do with it).


Unlikely friendships develop between elderly and not-so-elderly people I find and my next call took me south to a small flat where an 86 year-old man had vomited. His much younger friend (by about 30 years) was on scene and told me that he thought a reaction to medicine was to blame but after looking at the patient and finding out a bit more than was given to me by the initial descriptor, I had to assume food poisoning was to blame (probably).

The man was lying on his living room floor; he was very pale and a large pool of vomit (more of a mound really) was freshly deposited next to him. As I sat the man up and lifted him onto his sofa I deliberated whether or not to call an ambulance or take him myself. I decided he was too sick to risk taking in the car but was told that no ambulance was available.

After further obs and an improvement in the man’s condition I thought the risk was now less and I could take him in the car, so I got him ready for the trip and cancelled the ambulance (there wasn’t one coming anyway).

Meanwhile his friend mopped up the thick vomit with toilet paper (and unprotected hands). ‘What’s this you’ve been eating – porridge?’ he quipped. I thought that was a sign of real friendship (the vomit mopping, not the quip).

The trip to hospital was uneventful and the man’s colour had returned to his face by the time we got there.



Lifting a heavy door when you already have a bad back is probably not a good idea. My 35 year-old South African patient was working on replacing doors in an office when he fell victim to his own self-confidence. The pain was severe enough for him to need Entonox for the whole (long) trip to hospital through rubbish traffic. He was nice to chat to though.


Off to a dance studio (where young females prance around in skimpy clothing, so a nightmare scenario for me obviously) to tend to the knee of an injured 24 year-old who had a history of dislocation during practise. Now she had the same problem again, only this time her naughty knee popped back in after insulting her mid-routine. She too needed Entonox and that sorted her out almost immediately; some people just love the stuff! I drove her to hospital while she and her friend sat in the back of the car discussing how flexible their friends were. Nothing to put me off driving then.


My next patient sat in the back of the car with her husband, accusing him of leading her into a life of drugs before attempting to strangle herself. They’d both been waiting for me in the street – the call had been made for a female bleeding PV, which she confirmed when I arrived, although the connection between that problem and her alleged use of Heroin for the first time eluded me. Basically the conversation switched between the BPV, her hostility towards her husband and a story about a man who gave her class A drugs. Somewhere in the middle of it was me, sitting at the wheel wondering what the Hell I’d got myself into.

I warned them both that any further misbehaviour (like the strangling routine) wouldn’t be tolerated and off we went – quickly. I was already committed to taking them so I wanted to get rid of them rapidly; they caused me a lot of concern. There's nothing more bizarre than watching someone attempting to strangle themselves in broad daylight after accusing a spouse of getting them hooked on dangerous drugs whilst simultaneously suffering from a potential miscarriage.


I was called to my first blind man today. The 29 year-old lives alone in a council flat and he called an ambulance because he’d developed a right-sided headache that just wouldn’t go. He was also vomiting. The call descriptor read ‘vomiting blind’, which initially had me thinking I was going to a seriously drunk person - someone who was so damned drunk and throwing up so much their eyesight was lost.

I walked in to his home and he was lying on the sofa. He was the saddest looking man I’ve seen in a while and my heart went out to him as he struggled to tell me what was wrong. His obs were normal but that doesn’t mean anything; the whole one-sided headache thing is worth looking into.

He walked down to the car with me, cane in hand, and we travelled less than a mile to hospital. He didn’t say a word. He just sat in the back with his headache and his worries. A young life shouldn’t have those burdens. A young life shouldn’t be blind - or suffering anything for that matter.

Be safe.

Monday, 13 April 2009

Parasites

When there are no consequences to a threat, people do as they please.

Day shift: Four calls; One declined, one treated on-scene, one conveyed and one by ambulance.

Stats: 1 Head injury; 1 Migraine; 1 Faint; 1 Panic attack

The new television programme 'The Hospital' is making waves with its hard-hitting, in-your-face look at our current social decline and the resulting pressure on the NHS. So far, it has covered teen binge-drinking and teen pregnancy - the next episode will look at obesity. The cost of caring for these frankly irresponsible individuals should shock you, so I highly recommend that you watch it.

One of the pregnant teens, an obese, chain-smoking, needle-phobic young girl with a bad attitude was asked if she was concerned about the cost of having her baby (at least £10,000) courtesy of the tax-payers who fund the NHS. 'I'm not bothered about it...I might have made the next Prime Minister', she replied. I don't think so love, what you have probably made is yet another addition to the future parasitic generation of work-shy, law-breaking, sponging and ignorant youth that not only shame young people who have had a decent up-bringing and are trying to get on in the world but drain society of its hard-earned cash, by direct or indirect theft.

And before you get all heated up about this, in her own words she admitted getting pregnant because it was the only way she would have someone to love her and stay with her. You can blame her parents for that...not me.

This shift started very slowly indeed and I was glad of it – it gave me a chance to re-charge my batteries a little. Nothing happened in the morning and then, as the weather improved and the tourists and Easter Bank Holiday families started to pour into town, things got more hectic. I still only got collared for four calls though.


The first was to a Hawaiian woman who’d fallen o the steps outside an Opera House. She and her daughter were both in the company of the CRU medic when I arrived and the fuss had died down – she had a bump to the front of her head. She declined further aid and didn’t want to go to hospital, so she was left with advice and a couple of smiles.


Then a 21 year-old with her worst ever migraine (which they all have to say by law) had me driving her to hospital when her husband could have taken her (he was on his way but her bosses wanted an ambulance). She wouldn’t have died I’m sure and I sympathise with the condition, I truly do but there’s not much can be done for it, in or out of A&E. Needless to say she was left waiting for hours before being seen.


Another 21 year-old female fainted or possibly had a fit, nobody seemed to know, but she had a history of seizures in childhood apparently, so I asked for an ambulance instead of risking the trip in the car – she was determined to pass out on me I think and was doing a swooning sway as she sat with her colleagues around her. The swoon stopped when she was no longer in their sight.


I went home after dealing with a 31 year-old woman who was having a panic attack at an underground station. She lay on the floor, shaking in short tremors with stiffened limbs, almost as if she was fitting. Her boyfriend looked on as underground staff attempted to comfort her. She wasn’t fitting and I managed to get her to calm down, slow her breathing and explain her problems. I won’t share them with you because they are nobody’s business but hers. She would have to face them herself and then she’d stop having such drastic emotional events in public places.

Panic attacks can provoke and promote other physical problems and can lead to illness, so I always try to get the patient to examine the root problem of their feelings so that they can analyse them instead of reacting to them. That said, not everyone will agree with me and that’s fine but it’s the way I see the world and we have very little time these days for emotional crises when people are in genuine need of urgent attention. Fair enough?

Be safe.

Thursday, 9 April 2009

Teamwork

Day shift: Six calls; All by ambulance.

Stats: 1 Transfer; 2 RTCs; 1 Testicle pain; 1 Head injury; 1 Birth.


No matter how many times we bitch and moan about our lot (and these days we should be thankful to have a job at all), every now and then we get shifts that remind us we are all part of a team, or at least most of us can work very well together in high tension circumstances.


The first call of the day was a typical ambulance job – a transfer from one hospital to another. The patient was a methadone user who’d had a TIA (one of many in his history) and needed to be taken to a specialist unit for observation. He walked on and off again, reading his paper and relaxing in the back of the ambulance during the trip. There was nothing for me to do – I didn’t need to attend at all and so I chatted to my crew mate as we trundled along.


Two RTC’s today and this first one was a minor injury. A 40 year-old female was standing behind a bus when it turned out of a station, clipping her on the back at 5mph. She almost fell but didn’t quite although an ambulance was called because she complained of back pain. The solicitor was on her way to work and her husband was with her to see her off. Both ended up going to hospital – she went for treatment and he went for a visit. The husband drove himself there in the family car as his wife sat in the ambulance with me, hugged her Prada bag, cried, vomited and winced all the way. Eventually, at our destination, I got her to smile a little.


My crew mate had just finished telling me how she attracted only dull jobs and that the record for dragging crew mates through slow days was unbroken until we got this call; a woman cyclist had been run over by a cement mixing lorry and was trapped underneath. As we got underway, the details updated to ‘cardiac arrest’.

On scene, an ambulance crew, FRU paramedic and several CRU medics were attending to the patient. Police had sealed off the road but hundreds of people lined the pavements to see what was going on. What they witnessed was horrific.

The young woman had been caught underneath the lorry as it turned a corner – I’m not sure if she was cycling on the inside of it and couldn’t be seen. She was dragged under and crushed by the wheels. Now she was dying on the road with massive injuries.

CPR was in progress and my crew mate and I became part of that team as soon as we got her out from under the rear wheel. Fire crews had cut away her bike, which was a mangled mess, because it had trapped her legs, making it impossible to move her body. When she was clear we quickly got her into the ambulance and I continued to ventilate her as compressions were carried out. Everything that had to be done was completed before we’d moved her and as far as I was concerned she was as stable as we were ever going to get her.

Just before we left for hospital, a doctor appeared – she’d been requested as a matter of routine because of the nature of the incident. She climbed on board and began to do what she felt was needed. As is commonly practiced by emergency doctors, including those on HEMS, a scalpel was used to aid access to the internal organs – one hole on each side of the chest in preparation for a thoracotomy.

The woman had become very pale and her pupils were dilated, so all the signs were bad. When we arrived at hospital I looked down to see blood pooling on the floor of the ambulance – lots of blood. The efforts to save this woman’s life had been extreme, as necessary but she had lost a lot of fluid as a result, despite the replacement saline. Every compression had simply pushed volume from her – a dramatic and unfortunate consequence of the attempt to keep her going.

We returned to the scene because our ambulance was still there – we had travelled with the other crew. The police very kindly drove us back and as we recovered ourselves and sat in a coffee shop right next to the lorry, the manager asked us if she’d made it. She knew from our faces that she hadn’t – it had been called by the doctors twenty minutes after arriving in Resus. Then she went to the door, began to cry and lit up a cigarette. I went to see if I could say anything to comfort her.

During the conversation with her I discovered that she had been one of the first outside when the incident took place, right at the door. She had held the woman’s hand and spoken with her for a few seconds before she had ‘faded’, as she put it.

Inside the cafĂ©, the police were talking quietly to other witnesses, including a pregnant lady who had been next to the woman when she was hit. These people, including the lorry driver, would have to live with this for the rest of their lives and someone’s family would grieve for a long time about the tragic loss of a loved one.

I am wary about reporting these incidents because I really don’t want to upset people who might know the patient – I try not to be dramatic because this isn’t entertainment, it’s horrible and real but I for one don’t want to see any more young lives destroyed by incidents like this – if she was cycling on the inside of this large vehicle and the driver could not see her, then a tragedy was inevitable. If she was being careful, then we need to re-evaluate the purpose of having large vehicles moving around in tight spaces during busy periods when cyclists are everywhere. Or the roads need to be re-mapped to accommodate them safely. This article shockingly highlights the problem we face, particularly for female cyclists. I was on shift the day of the first incident but hadn't been called to it because we were too busy attending a hoax call just up the road.

I left the scene with my crew mate when the circling cylinder of cement was finally switched off.


The man with testicular pain was a 40 year-old Italian who had endured months of pain because his GP had given him antibiotics without even examining the problem. A CRU was on scene and we had a look at the problem - nothing was obvious but his history of pain and discomfort was in no doubt. We took him to hospital in the hope that someone would actually look at his injured area before diagnosing it.


A 75 year-old fell while going to the toilet and his son called us because this wasn’t the first time he’d stumbled and hurt himself. He had an old injury on his head and a fresh one where he’d landed on the toilet seat as he collapsed. He’d had a TIA last year and was left with speech and movement problems – this made it difficult for me to understand him and moving him was awkward. The lift we travelled in had to be the smallest I’ve ever come across – I was practically hugging him in it, such was the squeeze.

He remained alert and stable during the journey to hospital and I had finally mastered listening to him when he spoke, slurred and muddled as his language often was.


We get to witness the great contrast in life and death on this job – it’s a privilege and a shocker at the same time. For once the day ended with something to remind me of life after the cyclist's death earlier.

We were on our way to an imminent birth and fully expected to be delivering a baby on scene but were beaten to it by the FRU EMT, who’d arrived a few minutes before us. A MRU was also on scene and as we knocked on the door we could hear the cries of a new-born.

This should have been straight-forward; it was the woman’s third child and the baby was fine – wrapped in a light blanket in the arms of the EMT. Mum was lying on a bed in a tight little room and the father stood at a distance as if he was barred from the ceremony. The baby was handed to him so that he could say hello to his new son and let the other kids see their new sibling – he was so happy that he began to hand out drinks to everyone – bottles of still water.

The placenta had not yet been delivered and the mother had contractions, so we waited. A midwife was requested, so that we could have the mum and baby checked and left at home but she could not be reached – the on-call midwife was on voicemail!

I waited for another half hour and the MRU paramedic left the scene. Another crew arrived and I made a decision – we would take her to hospital for the delivery of the afterbirth – it could get complicated otherwise. Syntometrine is used routinely by midwives in these circumstances but we only use the drug if there is significant bleeding associated with the birth, so she was best taken to a place where it could be given if necessary.

Again, we worked as a team to get the woman out of the little bedroom and into the ambulance – it took five of us to do it but it went smoothly. Both mum and baby were taken up to the delivery suite and left in capable hands. If the midwife had come when requested, I have no doubt the trip would have been unnecessary. Some teams work and some don’t I guess.

Be safe.

Wednesday, 8 April 2009

Twitch in time

Early shift: Six calls; one hoax, the rest by ambulance.

Stats: 1 Head injury; 1 ? TIA; 1 ? # Femur; 1 Hyperglycaemic with AF; 1 Heart failure.


This is my pool shift week on ambulances and I attended on both shifts. Before our MDT failed and we had to wait just over an hour for a repair, we were called to a 36 year-old woman who had discharged herself from hospital after being admitted the night before with a head injury. She had jumped from a moving taxi and had been diagnosed, after a scan, with a brain contusion.

Now she was at home, lying in bed and complaining very loudly about her headache and ‘pain all over’. Her obs were normal but given the circumstances and recent diagnosis, it was best to get her back to hospital.

During the journey, she moaned and cried relentlessly but most of her discomfort seemed to be hidden underneath something else – self pity I think. While I booked her in and my crew mate stood by the trolley bed, she cried even more loudly and looked around to see if anyone was paying attention to her.

One of the nurses recognised her and I was given the full story. She’d hailed a taxi to get home but refused to pay the fare, so the driver drove her towards the nearest police station with the intention of turning her over to the cops. Not being one to stick around and explain herself, she opened the cab door and threw herself onto the road. Obviously, the cabbie had forgotten to lock the doors.

She was taken to hospital and spent a few hours there before discharging herself soon after one of the nurses caught her with crack cocaine in her possession, which neatly explains why she took such drastic action in the taxi.


An 86 year-old man got off a train with his wife and suddenly felt dizzy. His wife said that he had developed an unequal smile and she was concerned that he was having a stroke. He had a history of CABG and a valve replacement ten years earlier, so there was a need for caution here but his FAST check was negative and he appeared to have no facial droop when I examined him.

Every time an advertisement campaign is launched for a particular medical emergency, we see more and more false alarms, which use up resources of course. The latest campaign is for stroke.

We took the man and his wife to hospital – better safe than sorry. He may have had a TIA but he may have just got up out of his seat too quickly.


A 65 year-old man fell in the street and several people helped him to his feet again. He continued his walk and made it to his local drop-in centre at a church, where he gets his lunch. He sat down and couldn’t get up again. His thigh was very painful and he found that moving it was excruciating, so an ambulance was called and we arrived within a few minutes.

I examined his leg as he sat in the chair and I could feel a distinct lump a few inches below his hip. I asked him to remove everything from his pocket, just in case I was making a mistake but it was still there. I knew I’d need to have a proper look at his leg, so we carefully moved him onto a trolley bed and wheeled him out to the ambulance.

Inside the ambulance, I helped him remove his trousers and his injury was obvious. A large bruised, swollen lump on his thigh muscle indicated (at least the possibility) of a fracture. A bruised muscle probably wouldn’t have caused such pain or immobility and at his age bones tend to be less able to survive the energy of a fall, even from standing.

If he had a fractured femur and it remained stable, he would be fine but if it moved too much, he could bleed a lot and the injury could become life threatening, so we put a splint on the leg and got him to hospital for an x-ray.


The next call looked like a hoax ‘callbox, unknown problem, caller hung up’. When school kids are on holiday this is how a few of them entertain themselves. Obviously, we had to go and investigate the call and, not surprisingly, there was nobody on scene to worry about.


A strange call to an 87 year-old Cypriot woman who had developed facial twitching that could be timed almost to the second. Every 22 minutes precisely, she would turn her head to the left, stare at nothing, and her face (on that side) would spasm. This would last for up to a minute then she would be back to normal. I wasn’t sure at first and doubted the accuracy of her grand-daughter’s statement but she’d been timing it until we arrived, so I waited as I carried out my obs, for the next event.

The lady’s BM was high – the meter read ‘over 33.3’ so this was a significant factor because there was the possibility that her hyperglycaemia could be causing Epilepsia Partialis Continua (EPC). When all the obs were done and time was just about up, I checked my watch and as the 22nd minute rolled on, my patient’s head turned to the left and a facial tick developed. It lasted about 20 seconds.

On the way to hospital it happened again and I discovered AF on her ECG; something that I couldn’t connect with the event I was witnessing but that could put her in jeopardy if I was correct about the insulin depletion.

I left her and her family at the hospital and was unable to go back and find out what the actual diagnosis was, so I'm hoping for input from them at some point.


Our last call was to a 92 year-old woman with heart failure and the swollen ankles to go with it. Her GP had ordered an ambulance after her ankles had become much worse overnight but the lady sat in her chair watching telly in her sheltered accommodation flat and adamantly refused to believe she had any medical need to go to hospital. ‘I don’t know what all this fuss is about’, she said to me. ‘I’m nearly a hundred you know’.

I find it fascinating that women (and I’m generalising) spend a huge chunk of their lives keeping their age a secret until they are so old that it’s pointless and they start telling everyone, whether they ask or not. Men will tell you which war they fought in.

Be safe.

Thursday, 2 April 2009

Hard pills to swallow (600 of them)

Night shift: Ten calls; one treated on scene, one assisted-only, one false alarm, the rest by ambulance.

Stats:1 Heart problem; 1 Attempted suicide; 3 eTOH fall with head injury; 1 Smoke inhalation; 1Faint; 1 DOAB; 1? PE.


Apparently it's safe for us solos to move around after dark, so I'm back on the car. My first call was a NPC for a 43 year-old with heart trouble. The crew was on scene and all I had to do was move a few tables so that we could access the ramp for the trolley bed. This means that the ramp, which is meant for wheelchair access and in an emergency (fire for instance) would come in very useful, was blocked by tables and chairs.


A man in a hotel claimed to have taken more than 600 pills to kill himself but he wasn’t very good at it and not very convincing because, even though he said he’d taken them all three hours earlier, he showed absolutely no signs of overdose. The empty foils were there and they certainly testified to the number of tablets allegedly swallowed but vomit in the sink and my creeping suspicion that he’d dumped the rest overboard made me less than sympathetic about his cry for help. His colleagues were around and they showed reasonable concern of course but I’m guessing his credibility is tarnished for good.

His excuse for doing this was that he had ‘too many problems' in his life and as my consideration for his plight diminished I thought of hundreds of people I’d known who were having troubles of their own to contend with.


The first of a few drunken falls, resulting in minor head injuries next and a 30 year-old woman who confessed to being ‘not well’ and having depression meant that our boozed-up weekends were underway. She had a bruised cheek and I sat her in the car until the knights in green armour showed up to take her away.


Then off to a police station cell to see a woman who had been in her house when it burned to the ground. She still had sooty hands and was worried that she’d inhaled too much smoke because she’d vomited and was oozing black snot from her nose (well, where else?). Her breathing was fine and her sats were high, so I told her not to worry. She was under arrest and the cops preferred it if she stayed where she was. She agreed with them, which is unusual, and remained amicable throughout my time with her. I don’t know why she’d been arrested but arson was a distinct possibility.

She was also a self-harmer and had fresh slash wounds on her arm. I offered to dress them and the duty sergeant asked me not to put the dressing on that I had just unpacked. It took me a few seconds but his request that I use only gauze and tape lit my mental light bulb up (I’ve been a bit slow these days – tiredness I guess). His fear that the woman might use the lengths of bandage on the dressing to hang herself was logical but it would be bizarre to see her attempt it.


The next call was a NPC for a fainting 30 year-old male. It was an Amber1 that sent me four miles out of my area just so that I could watch an ambulance trundle on scene ahead of me.


A regular caller phoned in with abuse and the statement ‘I’m going to die in twenty minutes’ as he complained of suffering from an asthma attack. I was called and advised to take care (like I don’t always) but the police were there in force. They’d dragged him from the callbox on a separate issue – probably general abuse of the public – and were confused about why I was there. He was being cuffed as I did my paperwork.


On my way to the first DOAB of the night, a stupid man waved me to stop and I slowed, thinking there was probably an emergency I could actually help with but he smiled as my window rolled down and said ‘hello’ in a drunken, cheery singing voice. People like that make me fume (I’m using milder words for the sake of younger readers).

The DOAB was, as usual, a waste of time and money and the crew turned up before I could cancel them. The description given by the bus driver was that there was ‘no smell of alcohol’ but he was wrong and his nose needed examined. The guy reeked of it as he staggered off the bus.


A 64 year-old man with a recent history of blood clots in his legs showed all the signs of a possible Pulmonary Embolism, including a high BP and I worked with the crew to keep him comfortable and get him to A&E quickly. These things can go bad without warning.


Outside Downing Street I watched a lone protestor (a hangover from the G20 fun and games) as he shouted and pointed in the faces of the five heavily armed police officers guarding the entrance gates. I thought he might just push his luck and get shot if he didn’t back off but the cops just stood there and let him exercise his right to ruin their night shift. I would have paid good money to know what they were thinking as they stared at his random finger and abusive face.


It’s no good ‘mucking about’ in a dark night club if you are too drunk to stay upright, so the 25 year-old woman I attended with a laceration to her scalp, caused by falling into a door, would probably need reminding when she sobered up the next morning. The Booze Bus took her to hospital for that very purpose.


Over the years, especially when I started with LAS, I found that drunken men who needed sympathy, kissed my gloved hand, like I was the Pope. I always find it a bit strange when they do that and I wonder if they wake up the next day and remember how silly they’d been. A 36 year-old man who fell and cracked his head on the pavement repeated the act as he told me how kind I was. I’d heard his story – he had gone out and got very, very drunk because he had left his wife. He cried real tears as he sat and reflected on what he had just said and I suggested he speak to her when his mobile started ringing and he told me it was her. He refused to answer it and I picked it up the next time it rang and spoke to her myself. I didn’t want the poor woman worrying about him all night and if they’d had a fight, it was probably time to settle things before he got himself run over on the road.

His wife’s name was the same as mine, so I had the feeling that I knew her, even though I didn’t. I told her he was okay and that the ambulance crew (the Booze Bus was now on scene) would take him to hospital. She was crying and said ‘I can hear the drunken idiot in the background’. I felt sorry for her and I'm sure he'd left her worrying all night long. Hopefully, they’ll make up and sort themselves out – alcohol isn’t the cure.

Be safe.

Wednesday, 1 April 2009

People with issues

Night shift: Six calls; one declined, five by ambulance.

Stats: 1 Fall with ? dislocated hip; 1 Hernia; 1 Psychiatric problems; 2 eTOH.


The whole G20 debacle meant that all solo responders were taken off the road and placed on ambulances...yep, even the bikers lost their wheels. A cordon was placed around the City and all calls to that part of London were dealt with by in-situ resources because it was just too dangerous for us. Consider that; we are at risk from green and anti-capitalist protestors. Why? Not because we are rich or destroy the environment but because we portray the establishment. Anything in uniform it would seem, so the Scout movement better be afraid...

A man died of a heart attack on those streets amid trouble sparked by a few air-heads with issues and no solutions (I saw a poster declaring ‘ban money’ written on it). It didn’t help that a minority of arrogant and very, very stupid City workers allegedly waved money out of the windows to inflame the situation. So, the poor man died because there was a delay in getting medical aid to him (apparently). Plenty of people tried to help him and the police, I heard, were assaulted with bricks and debris as they attempted to get his body clear of the area.

We are now officially a lost and sad tribe. We don’t want the system we have but we have no alternative that’s any better...not a holistic solution at any rate. We know the problems that could be solved (like crime and punishment being out of step) but we do nothing to help ourselves. We are pigs in mire.

So, I’m on an ambulance and with a lovely crew mate that I have known for years but never worked with in all that time. We get on well, so the shift is pleasant.


A 46 year-old man (a large, heavy man) was lifting cartons of goods from one place to another when he stumbled and fell awkwardly. Now his hip is giving him pain (he heard it crack on the way down). His body had twisted, so it’s possible the joint came out of place, probably temporarily. We found him sitting on a chair, refusing to move and jumping out of his skin with pain every time I go near his injured leg. At one point I’d done nothing more than touch the fabric of his trousers when he cried out in an agony that simply couldn’t have been caused by me.

It took us a long time and a lot of entonox gas to move him into the ambulance. First of all, I had to wheel him out to the warehouse door using the office chair he was in, then a painful transfer onto the back of a railway buggy followed (he dragged himself onto the back seat in true slow motion). The buggy took him (and me) to the ambulance, where he was lifted onto the trolley bed, which my crew mate had made ready for him. He was very loud about his pain and it all seemed out of proportion with his big frame. Even his colleagues were shocked at his reaction.

When we got to A&E, he was quiet as a lamb – he even smiled a couple of times. Where had his pain gone?


As usual with ambulance work, there is always the possibility of a transfer and we got one to a south London hospital for a 4 year-old boy with a serious hernia. He was with his parents and it took us an hour to get him aboard, drive him to his new hospital (for an operation) and settle him in. All the way he played happily with his family and even though he had a painful problem, he didn’t complain once. I’m afraid I had to contrast his bravery with the last patient’s childishness; although I’m sure a few of you will still me for being judgmental about people’s pain. This wasn’t about thresholds; it was about dignity and behaviour.


The next patient – a methadone user - declined to go to hospital. He had a history of pericarditis and had suffered chest pain, provoking a 999 call, but now it was gone and he felt better. His ECG wasn’t super-normal but then it wouldn’t be. He declined despite my best efforts to persuade him to go, so he was left with his paperwork and a copy of the ECG.


Late night psychiatric calls are un-nerving and the next patient, a tall Somalian man with a history of paranoid schizophrenia, hung out of his hostel window shouting at us as we arrived on scene, making it all very cosy to start with. The call descriptor had stated that he was annoyed because people were laughing at him and that he’d had his hand burned by someone. He had a recent history of assault but the police refused to come and back us up on this one because they’d already been called five times today by him. I was hoping that he wouldn’t decide not to like us because the hostel staff didn’t look handy enough to help us out if he didn't.

At first he was angry – shouting at me all the time but then, when I agreed to take him to hospital (he had no illness or injury) after he’d threatened to kill himself if I didn’t, his demeanour changed and he smiled more and chatted too often.

At hospital, he continued his chatting (mostly to himself) as I booked him in. He got a cubicle and the freedom to wander in and out for cigarette breaks as and when he pleased. He had a loud, meandering voice that reminded me a lot of Bubbles Devere, the Little Britain character who spends her life at a private health club (if you are a fan, you’ll know who I mean).


A small, overweight 23 year-old girl with a skirt that was so short there was little point in wearing it, collapsed drunk on a Soho pavement and was rescued by passers-by who called an ambulance. She couldn’t remember her own name and sat in the back with us, desperately trying to recall it. Her date of birth proved to be even more elusive but she had no problem with her postcode, so she just repeated that over and over again whenever I asked her a question.

I sat her in the A&E Waiting area and she went to sleep. She was still there - fast asleep, when I took the next patient in.


It all ended with a 27 year-old man who was drunk outside a train station. He had been in a club with his friend and they had become separated. He’d wandered off and got mixed up with a stranger who’d offered him drugs, although he denied taking any. He’d been gone two hours, according to his friend, so it’s possible a lot more than looking at drugs had gone on.

He became emotional and said his drink may have been spiked...then he acted as if it had by complaining of abdominal pain and crying a lot. When we took him in to hospital, the A&E nurse wasn’t impressed at all and he was sent to the front to wait on a seat not too far from the overweight drunken short-skirted girl who was now in an alcoholic coma.

Be safe.