Thursday, 27 August 2009

Crumbs

Saw this in a local supermarket; kind of says it all.

Day shift: Six calls; two treated on scene and four by ambulance.

Stats: 2 Falls; 1 Panic attack; 1 Chest infection; 1 Faint with head injury; 1 Seizure with head injury.


My second ambulance shift and I am crewed up with someone who has as crazy a sense of humour as me, so we don face masks, look serious and form the LAS ‘Swine Flu Crew’ just for the hell of it and on our way to the first call, which may have been a non-runner anyway, I introduce my wing mirror to its cousin, belonging to a white van that attempted to get out my way by driving right into me at a junction. Oh well, these things happen. The damage was fairly superficial but we still had to stop and swap details, as the law demands. We were cancelled on the call, of course.


But the first actual call we attended was for a 14-month old baby boy who fell out of his buggy and cracked his head on the hard, unwashed floor of a bus station. Mum wasn’t happy at all, claiming that neither the staff nor the people sitting around waiting for their coaches attempted to help her as she struggled to hold on to her many bags and recover her broken child at the same time. I felt sorry for her; she’d travelled from over 100 miles already just to get here for the onward journey north. She had another 200 miles to go and was alone with her baby and her life’s belongings as she relocated back to her parent’s house.

The little boy’s head was bruised and there was a decent bump on it but this is normal for children – they have more water than brain inside their craniums, so parents and school staff need to calm down and reconsider reaching for the phone to dial 999 every time one appears on a post-fallen kid. Our remit was simple; we examine the child, assess the possibilities and decide, with mum’s involvement, whether or not the child should go to hospital and ruin their day. They’d already missed their coach and the next one was a two-hour wait away. The staff had agreed to get her safely on that one and promised her that she could wait in the quieter, more secluded lounge area, away from the mainstream general public.

We concluded that the boy’s head would survive the trauma – he was active; lively in fact, happy and smiley, so there was no immediate need to spoil his day or interrupt their journey. Mum accepted this and agreed, after arguing against it, to be led to the quiet waiting room – she was still angry about the staff’s initial lack of response and was reluctant to accept their kindly (and apologetic) offer to amend her hurt.

We left her there and made our way back to our own area but Control had other ideas and returned us to the same location for another faller. A 52 year-old lady had stumbled and two PCSO’s worried so much about it that an ambulance was requested. The lady, a lawyer on her way to work, had no injuries, no medical problems and no need for us. She’d just tripped over, as you do.


A 31 year-old woman had a panic attack at work (best place to have one) and we found her lying on the floor doing the classic starfish impression that is so indicative of someone who is not ill…or is dead. She was alive, however. She’d received some bad news, so started breathing rapidly to relieve the stress and now had numb fingers. She insisted on going to hospital, even though her entire treatment package stood in front of her (i.e. me, my colleague and anyone else who was willing to calm her down). Once again, the traumatic trip to hospital didn’t stop her making several phone calls in order to share her major medical condition with friends and relatives.


Outside a doctor’s surgery I found a 39 year-old man with a severe chest infection, a temperature of more than 38c, a rapid pulse, DIB and sats that were comparable to a wheezing asthmatic on his last legs. So, I found him outside the surgery. Outside. He’d been sent away by the medic, or psuedo-medic receptionist inside and told to call an ambulance because he had ‘Swine Flu’. He hadn’t been tested (cos they don’t), he hadn’t been assessed and no history, as far as he stated, had been taken. A cursory glance and a quick, somewhat panicky decision had been made, according to the man, whose friend was with him on the pavement.

A FRU was on scene and after some mutual eye-rolling at the apparent neglect of this patient; I was given a hand-over. The man looked very unwell; quite uncomfortable and should never have been left outside the very place that he’d entered for medical help. If he didn’t have piggy-flu, he had something much worse going on.


Later on, in the south, a 70 year-old woman who fainted and smacked her head on a wall as she dropped told us she ‘wasn’t going anywhere’ as we led her to the ambulance for checks. She was one of those stoical, ‘never been ill, never gonna be ill’, types and she was giving us our warning shot across the bow. I decided that, if she had nothing scary on the ECG (and other obs), then she could jolly well rejoin her friend and get on with her day trip to London.

Thankfully, she was a hard nut with no problems, except a little hypertension, and we all agreed that she’d be best off getting home after signing our ‘get out of jail free’ form. We also agreed to give her and her mate a lift to the coach station, where they’d get on board a bus for their journey back up north.


That’s how the day ended but me and my crew mate had discussed, debated and laughed our way through the entire shift. We chatted about crazy stuff that made no difference to anybody. Being on the FRU is a lonely existence and, although I do like to have time to myself and to work within my own boundaries, these ambulance shifts have reminded me of what a good crew mate can add to a long, hard working day.

Be safe.

Wednesday, 26 August 2009

Birthday boy

Someone, somewhere has too much time (and ink) on their hands. This was sent in to me after the revelation that I had a new nickname. You know who you are!

Day shift: Six calls; all by ambulance.

Stats: 1 Back pain; 1 Transfer; 1 Generally unwell; 1 ? Drug O/D; 1 Suicidal; 1 EP fit.


Two ambulance shifts coming up, starting with this one on my birthday and a routine day starting with a 25 year-old female with back pain who was 20 weeks pregnant. Her pain was severe enough to put her on her hands and knees at work and that’s how we found her, like a wounded animal on all fours on a sofa. She had retained her sense of humour, which is always useful if I’m going to be treating you, and she accepted pain relief as we moved her to the ambulance. She remained in her unbalanced position on the trolley bed and I had to drive like an old lady (no offence if you are an old lady who drives like a demon) to the hospital in case she fell over on to the floor.


Then a transfer from one hospital to another for a 76 year-old woman with Mitral Valve Stenosis and a need to be scanned and tested before any work could be done on her by the surgeons (if that was required). She remained quiet and calm as we moved her, accompanied by her daughter, two miles across town to the specialist unit that awaited her. There she was popped into a bed and we left her to the attention of other professional people.


A 77 year-old with a high temperature and a recent diagnosis of Swine Flu by her GP, lay in bed with an antibiotic (given to her by the GP despite the diagnosis) resistant cough as his worried family gathered around, thinking the worse. His age was certainly not in his favour and that cough sounded bad but it was more than likely due to a viral infection, thus the ineffectiveness of the antibiotics. Taking him to hospital by ambulance may not have been necessary but I guess if it had been my father/grandfather, I’d want him properly checked out and not given a dismissive and totally contradictory diagnosis over the phone.


The next call was given as a 25 year-old man ‘fitting’ in the street but he wasn’t. He had taken something. He was sitting on the pavement, where passers-by had apparently placed him after ‘some kind of seizure’, according to a local publican, who had come out to help deal with him when he collapsed. He was a tall, thin black man and his behaviour didn’t check the boxes for epilepsy. He looked and behaved as if he was under the influence of drugs. This made him an unknown entity to have on board, so we were cautious with him and, although he showed no sign that he may become violent, he remained silent and edgy all the way to hospital. Every now and then he would tense up and lash out with his fists and feet. He wasn’t aiming at anyone in particular but if I happened to be near enough to be caught by one of his out of control limbs, I would probably have felt the result. Security was placed on his cubicle when he arrived at hospital because they they too recognised his potential.


A no trace on the next call in the south and the police were on scene, waiting for our arrival. We searched three floors of a hostel for a man who said that he was about to kill himself. The hostel manager explained, in apologetic tones, that the man regularly called 999 claiming that he was suicidal and that, of course, he was a complete waste of time. The trouble is, one day he will probably go through with his intended act and we will look around for him, not find him and go away believing that he had, once again, given us a fire drill. I left the scene not knowing if I really cared or not.Our last call of the day was to a train station in which a Glaswegian lady was having a fit. She seemed totally recovered when we got there and, even though I asked her several times about her lifestyle and the possible involvement of lots of alcohol, she was adamant that she didn’t drink (much). Her face, physical appearance and attitude said otherwise and her fit may have been the result of withdrawal and not epilepsy. Nevertheless, experience, judgment and a sense of clinical targeting counts for nothing in the public domain and I wouldn’t want to be seen as arrogantly judgmental.


While she was lying on the floor of the pub (yep, the bar inside the station), one of the ladies working there pointed to a lump on her wrist and said that she may have broken it after falling to the floor. I had a look at it and realised it was nothing more than a ganglion; a neglected anomaly attached to the extremity of a woman in denial of her own self-abuse, so she was taken to hospital and that’s where she decided to be more forthcoming about her drinking habits (heavy and frequent).

Be safe.

Thursday, 20 August 2009

Amputation

Night shift: Five calls; one assisted-only, one by car and three by ambulance.

Stats: 2 Chest pain (one who was drunk); 1 Sprained ankles; 1 one-under; 1 eTOH.


Every now and then a nightshift will produce a single call that haunts you. This call will be significant for reasons you can’t put your finger on and will be surrounded on either side by mundane or routine stuff that you must still get through regardless. I have been careful not to go into too much detail with the call I am referring to but be aware that you may still not want to read it.


So, a chest pain call for a 48 year-old man who ‘refused to give the exact location’ meant I was heading for a troublemaker. I spent a while outside the tube station where the call had originated, practically accusing a Big Issue seller who was sitting on the pavement of making the call. ‘I wouldn’t do something like that’, he said. There was nobody else around who fitted the bill but I had to believe him – he had a believable face.

The crew arrived and we all had a good look around the area for this 'emergency' but still couldn’t find him. Until, that is, he hobbled across the road with anger on his face, crutches in one hand and a can of Special Brew in the other. As soon as I saw him darting towards us I knew he was our customer. He was livid that we hadn’t drawn up to where he was sitting, invisible and intoxicated. We are chariots of servitude for the self-abusing minority. We are there at the beck and call of those who pay no taxes and do no favours for society and right at that moment, as he almost collided with me and spilled his beer on my uniform, I felt lower than him just for turning up.

I took his beer can and poured the contents out into the gutter. He didn’t like that and objected with beery-breath and spittle as I walked him to the ambulance. ‘I’ve got chest pain’, he said. He may have had but his sprint, albeit on crutches, said he was in better health than any genuine heart attack victim I'd ever met.


Over on the busier side of town, a 52 year-old man sat outside a hostel waiting for me to arrive and examine his ankles. He’d sprained one of them three weeks earlier but had done nothing about it and had continued to walk about despite the huge swelling and the pain. He was homeless, thus had no choice but to keep on the move but his other ankle had been compensating for this and it too was now quite swollen. With both ankles effectively out of commission he was crippled and almost unable to stand at all. Luckily, he had some movement left in him and I was able to get him to the car for the trip to A&E. His feet smelled like rotten cabbage and when we got to hospital he dragged that aroma through the entire area to reception, where he was deposited in a chair to wait with everyone else. One of the nurses came shooting by with a can of air freshener and a dirty look for me.


Then later on this bizarre ‘one-under’ call came in. A one-under is a call in which someone has fallen under a train; usually there is nothing to do as the patient tends to be pretty dead but this one described the patient 'arguing' while under the train. He had fallen under while the train was moving, so I expected him to be dead, dying or seriously injured… certainly not talking to anyone. I assumed he must be a drunk who’d fallen in the gap between the train and the platform (it happens) but that he hadn’t actually been hurt by the train itself.

I rushed to the scene, half expecting to be cancelled but I wasn’t, and a crew and officer were already there and unpacking equipment. Someone was taking it seriously obviously. I had also been asked to report for HEMS and this indicated that more detail had been given than I had received so far.

We ran down to the platform and found that it hadn’t yet been cleared of passengers. There were quite a lot of people milling around, staring and trying to get a better look at the human railway sleeper lying below the stationary train. Railway personnel were on hand and someone was reaching down into the gap and holding a man’s hand. I looked into the narrow space and saw a very drunk man lying on his back with one of his arms reaching back over his head as if he was holding on to the train. At first it looked as if he had no injury and could simply be plucked out but when I asked for a closer look at where his arm was going we could see that the wheel of the train was on top of it, crushing it into a pulp on the rail – he was bleeding but not significantly. The man was completely unaware of his predicament.

I got down into the gap with my colleague and a couple of firefighters, who’d arrived on scene in force. We had been given assurances that the power was off but I never trust those promises and going down there was always going to be a risk. Personally, I don’t mind being under trains and have done this a number of times but the thought of a live rail making life nasty and short for me and my colleagues plays on the mind.

The man was so drunk that he continued to misunderstand where he was and why we were there. Even when I cannulated him and started fluids, he couldn’t figure out what was going on. Yet something about him stirred and his face would show it every now and again; his body knew he was in serious trouble even if his brain didn’t and every now and then his expression would change and he’d sober up for a few seconds.

‘Where am I?’ he asked me.

‘You’re under a train and we need to get you out’, I told him.

‘I need to speak to my wife’, he said with a sad, sombre expression.

I felt for him, I really did. He still didn’t know about his mangled hand. We had a plan to free him but he’d probably lose that hand one way or the other. An emergency doctor was now on scene but she pretty much left proceedings to us. I cut the circulation in his arm off with a tourniquet so that he didn’t bleed badly when the train was lifted off his hand. Then the firefighters set to work, cranking the train up slowly using a powerful manual Jack. It seemed to take ages because the wheel was only being elevated centimeters at a time.

The platform had been cleared of the general public but was now pretty full of uniformed people. All the while the train was being lifted, there was a calm quiet and it made things a little more unnerving for me. I was holding his arm and watching the hand literally peel off the wheel as it began to rise from the rail.

Just before we began the lift, he did something else that made me realize that he knew, beneath all that alcohol, he was in danger. He asked to hold my hand. ‘I don’t know why I want to but I just do’, he said. It was poignant and painful to watch a grown man struggle with this traumatic reality under tons of stinking train. He was still too drunk to feel any pain or know any better but his life was about to change forever.

I continued to watch his destroyed hand as it unglued from the metal of the train wheel; it was like watching a fake rubber hand being pulled out. When there was enough of a gap for the hand to finally be released, I gave his arm a gentle pull and hoped that I wouldn’t see his limb torn apart by the stress. Instead, his completely degloved hand came away and fell towards me, blood oozing from the crushed bones and sinews. The damage was severe and started at his wrist, with extensive avulsion all the way to his broken and missing fingers.

I guided his arm into a box splint which had been prepared with thick dressings and I listened as he screamed in pain – the first pain he had acknowledged since the accident had occurred. There was no pain relief for him at the moment; he’d have to wait until we’d freed him from under the train and the doctor could deal with him.

Once his arm had been released, we had no option but to sit him upright and haul him out of the gap like we would do with any drunken faller. His covered limb had to be carefully handled because the least movement made him cry out in agony. There was no time to waste with him either, so as soon as he was given pain relief, he was taken to the ambulance.

Outside in the ticket hall, the passengers who had witnessed the incident were waiting. Some of them had shocked looks on their faces, some were talking excitedly into their phones and most of them, I was told later, believed that we had just cut the man’s hand off to save his life.

We rushed him to hospital and he was taken into Resus where a trauma team took over. I still don’t know how he came to fall under a moving train and I don’t know how he got on. He will have survived of course but his hand was completely destroyed and so his career would more than likely be over. For some reason, the fact that his hand had been taken from him like that, hit me quite hard. If he had been killed under that train my reaction would have been very different and probably equal to any other I’ve had when dealing with traumatic death, but I still can’t forget this one and I think about it often.


After all that work and a debrief with the officer, who was a true gentleman, I was sent to wake up a DOAB. As usual, he was reported as ‘unconscious’ and, as usual, he wasn’t. It took no more than ten seconds to prove that.


My shift ended with a 46 year-old woman who had ‘breathing difficulties’ She was an asthma sufferer and her main complaint was left arm pain which had been going on for a few hours. She was in a hotel room with her husband and two kids (who were sleeping in a separate area) and she’d been trying to sleep when the pain and breathlessness took hold of her. A crew arrived as I was completing my obs and I left them to it. I was still processing what I had dealt with earlier, so I felt unnecessary at that point.

Some shifts test you and some leave you feeling emotionally drained. Tonight, I had been challenged by an unexpected call and was making my way home with only the memory of what had gone before running through my head. I was reflecting on it and that’s healthy. I wasn’t depressed or upset by it but I was shocked in the way that you are when you see someone in desperate trouble and you discover that it is your brother.

Be safe.

Friday, 14 August 2009

Personal problems

Day shift: Three calls; one by car and two by ambulance.

Stats: 1 Sleepy-head; 1 ?TIA; 1 Chest pain.


Not much shaking in Old London Town for me today – the sunshine and holidays made calling an ambulance unfashionable obviously and only the genuinely ill, injured or needy required my services. Either that or there was enough of us on duty for the call volume to seem benevolent.


A 38 year-old Portuguese woman, currently taking Diazepam for stress-induced insomnia, found herself falling asleep at work in the theatre where she cleaned. Obviously her employer was concerned about her safety and called an ambulance, thinking she may slip into a coma whilst buffing the floor. The poor woman spoke very little English, so it was down to her friend to translate and explain that she’d been worrying about something in her personal life (there are a lot of immigrant workers with this dilemma) whilst putting in the hours she needed to survive in the UK. The effects of a build-up of the drug in her system meant she couldn’t stay awake during the day but kept nocturnal waking hours instead (like I do on night shifts). The call was given as ‘unconscious’ but she’d never been near that and was simply ‘groggy’. We need a call category for this; ‘patient is groggy – red2’ it would state.


Bingo was being played on the 4th plinth at Trafalgar Square and I indulged them by taking a free card as I sat in the car. Of course I wasn’t taking it seriously but there were sweets to win and when I started crossing off numbers as they were called, I could feel the competitor in me chomping at the bit, eager to beat anyone to the call of ‘house!’ or ‘Bingo!’ or whatever the current word is. In fact, not knowing the current word for sure made me slightly nervous about the prospect of winning and I found myself wondering if I’d have the bottle to say anything if my numbers came up. Honestly, you’d think I was about to win a car.

In the end, someone else shouted out and beat me to it; I would have been livid but I was three or four numbers off anyway. The nice man who was giving out the prizes came over and lobbed in free sweets, despite the fact that I hadn’t won. The benefit of the uniform still surprises me. I hope the sweets don’t count as a bribe for free treatment (oh, wait a minute, it is free).


After the Bingo excitement, I was off to see a 51 year-old man who’d had a seizure in front of his colleagues at work. He’d recently been diagnosed with Prostate cancer and when he came round (he was very confused for a while when I got there) he denied this, even though his friend had just told me. I’d also been told he had taken time off sick but hadn’t told anyone at work the reason for this absence. I wondered if this meant he was keeping something serious from them and that his seizure had something to do with it. His face had suddenly ‘contorted’ just as he collapsed, I was informed.

I took the man to my car as he recovered and an ambulance pulled up to take him to hospital. I had seen pictures of his family around his office and it’s possible he was protecting them and his friends by withholding information about his health. He may have had a TIA, caused in turn by something else in his brain but it would be his secret until he decided to let people know – or he’d take it with him.


At the end of the day a 55 year-old woman collapsed then got herself up and walked, with her friend, to a restaurant, where she promptly collapsed again. She had a ‘heavy chest’ and was a known angina sufferer. Her ECG showed a racing SVT, so she was taken to hospital very quickly.

Some people try to get on with things despite their pain and discomfort. This lady didn’t want to cause a fuss so the restaurant manager had to call us to help her. If she'd been having a heart attack, she may have gone into cardiac arrest outside where she sat if they hadn’t. That would have ruined everyone’s day.

Be safe.

Thursday, 13 August 2009

Floppy

Day shift: Four calls; two by car and two by ambulance.

Stats: 1 Faint; 1 Fall; 1 DIB; 1 Etoh.


The fainter was a 28 year-old female who was also 13 weeks pregnant. She’d been standing on the tube train (thanks for giving up your seat for her people) when she began to lose her balance. The Portuguese woman wasn’t so far along in pregnancy that her blood pressure should be affected adversely but she would have felt the effect of gravity when standing for a while in a hot, crowded train. I took her to A&E in the car.


A dementia patient in a care home waited for ages for an ambulance but was such a low priority that the imminent arrival of a fully loaded emergency vehicle was unlikely, so I was asked to go and check him out. The 84 year-old Irishman had fallen a few times in the night and this was unusual for him, according to the staff on scene. He sat on a chair in the lounge and offered me his bank card for some reason only he knew about. I respectfully declined the offer and carried out my obs; I could see that he wasn’t aware of what was going on.

He was able to stand and walk and the ambulance wouldn’t be with him for at least another hour, so I opted to take him myself. His initial confusion was replaced with some clarity as he was taken to the car, so at least I wasn’t going to be transporting a potentially loaded gun.


The real emergency of the day was a call to a park for a 1 year-old boy with croup and breathing problems. His barking cough gave away his disease from a distance but he was floppy in his mother’s arms and his skin had begun to go grey. An ambulance pulled up as I carried out obs and got some oxygen over his face. His temperature was 39c and his worried mum needed eye contact from me constantly so that she could indentify confidence that all was well. As far as I was concerned, the boy needed to go to hospital very quickly, so the arrival of the ambulance was a relief because driving him in the car was going to be a difficult clinical decision to make. The oxygen had brought him back a little and he was more alert, so I carried him to the crew and they wasted no time in getting him on board with mum in tow.


I ended the shift with a 60 year-old man who’d ‘collapsed’ through drink at a bus station. He’d had a fight with his girlfriend and was a bit aggressive. The crew was already on scene when I pulled up for this ‘emergency’ and he was being attended to but I stuck around in case I was needed. I wasn’t but it gave the guy an excuse to become even more annoying as he refused to go to hospital and then, when the crew kindly offered to return him to his hostel, he hurled abuse at them. Sometimes being nice to people like that is just pointless.

Be safe.

Wednesday, 12 August 2009

Terminations


This is a bronze statue of James II. It's over 300 years old and was made by Grinling Gibbons. It stands outside the National Gallery on Trafalgar Square. In his right hand he is holding a traditional (not so bronze and not so old) empty lager can. Its all about culture in the UK.


Day shift: Six calls; four by car, one gone before arrival and one by ambulance.

Stats: 1 Head injury; 1 D&V; 1 Miscarriage; 1 SOB; 1 Tachycardic.


With my regular Student Paramedic (SP) on board, I set off for another exciting episode on the FRU and conveyed our first patient, a 36 year-old lawyer-type, who’d tripped on the kerb and hit her head on a lamp-post on the way to the ground. She had a nasty little cut to her forehead and a mild concussion. She cried in the car as we prepared to take her to A&E and I waited for a few minutes before driving off, so that my hand could reassure her hand that everything was okay. It seemed to work and she settled down.


Our next patient wasn’t so keen to have reassurance, however. We’d been called to a train station for a 25 year-old female who’d felt faint but, as it was only a Green call (which is fair enough) and nobody had been rushed to her aid for twenty minutes, she decided not to bother waiting. She would have fully recovered by then anyway.

I nearly lost my SP in the station; I’d asked her to go inside and try to locate the patient but, as our patient had long since left the scene and the railway staff seemed none the wiser, she was on an empty mission and I was elsewhere in the car. If I went back to where I dropped her off, I might miss her as she came out of another exit. If I stayed where I was, she may never appear again. It was one of those conundrums that you slide into without thinking and where there had been no fore-plan. Luckily, she came out of the correct exit and I was in position to pick her up and give her the good news about our fruitless journey.


Then back to the same train station as soon we were safely out of harm’s reach (yeah, right) for a 19 year-old woman with diarrhoea and vomiting (D&V). She’d had this problem on and off for months and that is enough to be concerned about but her sister had recently been diagnosed with bowel cancer. This young lady was, understandably, stressed and this can be enough to produce the D&V she suffered from but I can also understand her deep concern at the coincidental signs of serious illness. My money is on stress, however, as her problems began when her sister was first diagnosed.

We took her to A&E in the car and kept her smiling as much as possible all the way. We discussed IBS and other fun stuff to keep her head out of the mire of worry and in the here and now, for her own health. Best she thought of annoying but fairly innocuous problems than life-threatening ones, right?


Another heart-string pulling job came along soon after that one. A 40 year-old woman was sitting on a wall with a neighbour and a taxi driver by her side. She was pregnant with her first child and now there was more than a little bleeding going on down there. The taxi driver had been put on standby to take her to hospital if I didn’t show up. The call was given a low priority and I won’t even bother going into this interminable problem with this type of emergency. I’ve said enough in the book about how I feel when women lose babies and are given nothing but a shrug of the shoulders for their pain. Period pains, faints and dizziness are often of no real consequence; miscarriages are permanent psychological scars.

Her blood was trailing down the little wall and onto the soil beneath her. She was being strong and realistic about it and I just wanted to hug her. How many chances was she going to get at her age?

She stood up and walked gingerly to the car – she didn’t want the fuss of an ambulance and didn’t need it anyway. She needed TLC and some grown up appreciation for her current predicament. As she made her way, little spots of grey-tinged blood spattered the pavement. The neighbour watched and the taxi driver watched – both had sad faces and an understanding of the consequences of this departure.

I left this lovely lady in her cubicle in A&E after discussing the other possibilities with her, although we both knew I was talking to her about slim chances. ‘I’m ready to accept the loss’ she told me. ‘I’ve already told my husband that it’s probably gone’. I could imagine a grown man crying somewhere.


A regular caller with imaginary (probably, since it is his MO) shortness of breath (SOB) and a pain in his side, called 999 and had us attend to him at yet another railway station. He was as fake as an eleven-quid note but we still gave him the attention he required ‘cos that’s what we are all about, yes? As soon as we got him into the cubicle bed in A&E, he fell asleep, with no problem at all in the breathing department. I watched him as the SP gave her handover; his breathing pattern only changed when he knew he was being watched. Anyone can do that, mate.


Our last call was to a 65 year-old man with a history of rapid heart rate and who was now suffering a tachycardia that made him feel dizzy. Despite trying the usual things – valsalva and carotid sinus massage, his heart beat continued to run in the high 100’s. He had no chest pain but he did tell me he had Polymyalgia and Arteritis although he did say polymyalgic arteritis but he may have meant this separately or polyarteritis and if so, this was probably the contributing factor if the disease was adversely affecting his aortic artery.

We took him into the ambulance when the crew arrived and an ECG showed a narrow complex tachycardia, so he’d need to go to hospital quickly and get his heart muscle brought under control – either by drugs or, if things got worse, cardioversion, before his condition deteriorated and he went into VF. His blood pressure was dropping and continued to do so when he got to Resus. He’ll survive and his condition will have to be closely monitored for a while, I expect.

Today had been clinically interesting and emotionally challenging without being too busy or dramatic. It’s funny how certain jobs can affect your mood when you least expect it.

Be safe.

Sunday, 9 August 2009

Out of control

How annoying is it when you can't even park your Penny Farthing without having to chain it up?

Day shift: Six calls; two by car and four by ambulance.

Stats: 1 Chest pain; 1 Stiff leg(!); 1 Fractured hip; 1 Period pain; 1 Abdo pain; 1 Fractured arm.


N’s second shift with me and she’s scooting about Central London like a native now – except for her give-away activity of taking photos of everything remotely interesting, including a CRU colleague, although he did take a good picture to be honest.


Today must have been someone’s first day in Control because the call categories were skewed way off the patient realities. The first of the morning, across the river, for a 31 year-old woman was given as ‘pandemic’ and therefore categorised as Green2 (quite right) but when I got to the car in which she was sitting with her husband, I was told that she had chest pain, a recent heart attack history and was not sneezing, sniffing, vomiting or suffering a high temperature. Her husband stated that he had told the call-taker that his wife was having chest pains but this little nugget had somehow slipped the net and I had moseyed over to the call on the basis that I was in no hurry for Swine Flu (still on lights and sirens though – public place). This call was a Red for sure and now there was nobody coming to take her to hospital and because re-categorisation rarely seems to occur when I ask for it on air, I decided to take her across the bridge myself. It took two minutes to whisk her off to Resus – it may have taken twenty minutes for an ambulance to do so.


The next call was given as Amber but there were no priority symptoms given for the 80 year-old man who ‘can’t get off his chair’. When I got there, he was plonked on a stool, in his yellowish underwear, waiting for me like someone would wait for a taxi or a meal with wheels. He had no DIB, no SOB, no D&V, no MI and no CVA... he had a stiff leg. In fact, he’d suffered from that affliction for years so this morning was nothing new. The call should have been Green or given to a taxi driver ... or meals-on-wheels but an ambulance was there within a few minutes and he got the full NHS treatment for ‘rigid-leg syndrome’.


My colleagues in the Emergency Operations Centre (EOC) work hard and under stressful conditions at times, so I don’t knock them as people but even they would agree that the two calls I’ve just described were categorised (by man or machine) quite ineptly, either through dumb reasoning, the dumbing-down of the facts as they were heard or by the caller’s inability to get his point across properly. Call-takers are on a timer, you see. They have a limited time to get the call cleared and off to Dispatch (usually via the computer) so they are under enormous pressure to get the answers they need in as short a time as possible. This, in my opinion, can lead to what I call ‘factoid-deafness’ and inaccuracies in detail (or lack of them) and to make matters even worse, we are being sent a set of co-ordinates before a call has been fully screened and are expected to start running on it even though we don’t know exactly where it is or what it entails. Someone is going to get hurt as a result – a patient or a front-liner. But it all feeds the need for greater speed and efficiency, thus the upper echelons and the Government, whose idea this was in the first place, get their pats on the back when the figures come in. Target, target, target. Don't achieve anything, just get it on target.

Imagine a call being taken and the person at the other end being able to absorb every detail properly, with no pressure. Then imagine that call being despatched to me and my colleagues and we are able to check everything about it as we run on it. Imagine a country where the system isn’t overloaded by abuse, ignorance and public stupidity...


If your mother fell in the road, broke her hip and was in extreme pain, would you want her to (a) be taken by ambulance immediately to hospital or (b) lie there in pain for as long as possible?

A 60 year-old Nigerian woman suffered 40 minutes of agony, some of which I managed to relieve with entonox and morphine, after a tumble in the middle of the road left her neck of femur (NOF) broken. This is a nasty break in any circumstance but she had to be dragged across the road and laid against a car by members of the public to save her from being run over as well. The pain must have been excruciating.

I arrived to find her with a large family group that had gathered around her when they found out what had happened. The call was Green and the day just seemed to be so predictable. I knew that an ambulance was a long shot and this time I insisted again and again that it should be upgraded. It took three calls for this to happen but my MRU colleague on the desk managed to finally get things moving for her. I couldn’t convey, that was for sure and I’d been sent by the desk to assess and give pain relief because the clinical person there (MRU) had seen the potential in the call where someone else had not.

Again, if this was your mother, wouldn’t you want to have her treated quickly? Instead, an old man with a stiff leg gets an ambulance and this lady gets to wait. The system makes helping genuinely ill and injured people very difficult. Clinically trained individuals can screen most of the calls coming in and make fairly sound judgment calls about their priority status but the human element is completely removed by computers and nobody at the end of a 999 call in the Control room is allowed to change that without permission.


Calls to period pains annoy the hell out of me. This is not an emergency. I sympathise and I get a lot of flak from women who like to tell me how I will never know how bad it can be BUT it happens every month and there are ways of dealing with it. So, the 16 year-old Japanese girl who writhed about at an underground station after generating a Red call for an ‘unconscious female’ (which she clearly wasn’t) had me listening to a German doctor telling me that she had abdominal pains and that I could ‘take her away’ when her handover had been completed. This tourist (doctor or not) had literally pushed the underground staff member away when he attempted to give a report to me and then arrogantly proceeded to treat me like I was simply here to take the patient to hospital and no more.

‘I’ll tell you what happened here and then you can take her away’, she’d said. I was a wee bit annoyed with her.

‘She has period pain’, I said before the doc could finish.

‘No, she hasn’t – she has abdominal pain’, she replied.

‘Well, she’s just told everyone its period pain’, I said after hearing that being said more than once.

‘Oh, well, I have to go now anyway, so yes, you take her away now’. And with that, she walked off with her friend behind her.

The girl played this out to the point where she grabbed me so hard as I tried to stand her up and walk her to the car, that she tore into my flesh with her nails. She had her own pain relief for this but it was a Japanese remedy, her male friend told me. I had no idea whether it was an analgesic or some sort of natural herbal concoction. Whatever it was, it wasn’t very good and this wasn't her first period - she'd had many before.

My intention was to take the girl to hospital (if she insisted) in the car but an ambulance showed up and the crew were most welcome to take her. I had endured enough of her floor-wriggling performance. I’m sorry if this offends you and if you think that, yet again, Stu doesn’t care but I do, I care about people’s mums when they break their hips; I care about chest pains in cars – what I care less about, I’m afraid, are monthly episodes of discomfort that cannot be dealt with any better in hospital than they can at home.


Standing in the street, propped up by two walking sticks and a girlfriend, was a 39 year-old man, recently diagnosed with liver failure and possibly hepatitis. He had been instructed to call an ambulance if his pain became acute and now he waited for me to arrive after following that instruction. The call was given as chest pain (hmmm) but in this case, that seemed okay because he got a priority response and his pain was real. His liver was palpable under the skin and he looked unwell.

An ambulance arrived fairly quickly and he was taken to hospital. Throughout my short interaction with him, he remained stoical and well-mannered and I felt truly sorry for him as he hobbled into the back of the ‘truck’; if his liver was shot, he had little hope of a replacement.


The last call of the shift was a revelation in the mediocrity of human nature infused into the very core of certain people. To start with, I arrived and couldn’t see the patient, or anyone who wanted to show me where he was. The call was for a 15 year-old male with a broken arm. I was outside an arcade complex and one of the security men stood there, right in front of my car, without any indication on his face or body that he was waiting for me. He just stared in at us with that poker face. I called Control to ask for directions and the guard moved slowly towards me, staring in at me as if I was supposed to telepathically detect his request for me to follow him. He was probably the surliest looking individual I have ever seen in that profession.

I got the hint and pointed to him and then to myself in a ‘are you waiting for me?’ gesture. He neither shrugged nor moved a single facial muscle. His hands were stuck in his pockets and they remained there all the way up two flights of stairs and along seemingly endless corridors within the guts of the large complex. N and I followed him and our bemusement at his cant-be-bothered attitude and his apparently handless arms was magnified ten-fold when we met the patient.

Inside a little room, a teenage East European boy cradled his arm as a CRU colleague explained that he’d been using one of those punch-ball machines when he’d misjudged his aim or gone overboard with his machismo. His relatives (I think) stood with him and the dour-faced security man, hands in pockets, hovered, protecting no-one in particular.

The boy had a broken arm – there was little doubt about that because the bone was quite deformed – but he’d live. He didn’t display much in the way of pain and he was stable enough to go in the car.

‘Yeah, can we go now’, he rudely interrupted as my colleague attempted to complete his handover.

God, I thought, he’s moody and ill-mannered as well. I knew taking him in the car was going to be a treat for everyone. It was busy traffic-wise and his trip would take twenty minutes or so.

We went back down to the street with our hand-pocketed man ahead of us and were shown the exit with as much interest as he could muster – none. I packed the boy and one of his relatives (I think) in the back of the car, while the other one was asked to walk the two miles to A&E.

During the journey, my fractured teenage patient complained bitterly about how long it was taking and then cheekily told (not asked) me to put my lights and sirens on. I could have put him and the period-pain girl together on a date. I would pay good money to see how that one panned out.

When we got to hospital, he was booked in and the other relative (I think) walked in a few minutes later (that’s how slow London traffic can be). ‘Where is that young boy?’ he asked me. Now, I thought the two men with him were blood-relatives. I had made that assumption and I’m sure I had been told this but when he said that, I felt more than a little unsure about who he was. Maybe the man in A&E with him was a relative and this guy was just a friend but surely he’d know his name?


The shift transposed the emergent needy and the not-so-needy and I felt hollow about that. I wanted to do my best for the three genuine patients that I’d been called to and was forced to rush about on lights for three that could have taken care of themselves (yes, even a broken arm is a lesser emergency – Green call in fact). But this is my job and I still love it, no matter what you read here. Those who know me understand that. Without this diary, I would have no other place to dump my opinions and frustrations which, until the witch-hunting do-good minority get a hold of them, are still mine to expose as I please.

N has now experienced the difference in London but for her Service and every other ambulance Service in the country (the world in fact) the emotive element of the job requires no explanation other than it’s all the same and all very, very different.

Be safe.

Saturday, 8 August 2009

The STU-FRU

Someone, somewhere is missing an evil feline :-) This poster was displayed in a shop window in Soho.

Day shift: Six calls; one treated on scene, three by car and two by ambulance.

Stats: 1 Back pain; 1 Sprained ankle; 1 EP Fit; 1 Head injury; 2 Unwell at same place.


Apparently I've got a nickname - well, it's better than some of the others I've heard.


This weekend I was host to a Welsh Student Paramedic (I shall call her N) who wanted to find out what all the fuss was about in London. She found out straight away when she realised that what I described as ‘quiet traffic’ at 7am was more like full-on rush-hour to her!


A 40 year-old hotel doorman went to work after trying to keep his back pain in check with painkillers. He’d lifted a heavy weight a few days before and felt a twinge. His back was further insulted when he fell on an underground train. Now he was in agony, stuck in a small space, where he had been attempting to get changed for work; his trousers were at his ankles and he was unable to do much more with them.

I gave him entonox and made him breathe it in while I sorted out his attire (I couldn’t have him limping through a twenty-star hotel looking like a pervert, could I?) and carefully prepared him for the walking trip to the car. He made it there in painful slow motion as I steadied him. He declined morphine because he had a needle phobia. They all say that. Wait ‘til a nurse gets hold of him with one.


Sprains are fairly easy to recognise and diagnose but they have several grades of seriousness, depending on whether the ligament is damaged, partially-torn or completely ripped away. In some cases you may as well call a sprain a fracture because it amounts to the same thing (ligament tears from bone, bone is therefore damaged and so you have a fracture).

So the 31 year-old woman who tripped on a kerb and twisted her ankle had one and I called it a grade 2 on recognition, although an x-ray would be needed for confirmation. A swollen, rounded ankle with pain and the inability to weight-bear after that kind of twisting-fall is enough for me. An off-duty MRU paramedic was on scene and called me in to take the lady to hospital. She didn’t need an emergency ambulance because this type of injury simply doesn’t require the fuss (I’m now about to be bombarded with stories of ankles hanging off to disprove that).


A strange call to a 22 year-old who had a fit in her office while her colleagues looked on had a little twist to it. The woman was post ictal when I arrived; completely confused and disorientated but she also complained about having painful, swollen cheeks and jaws. I could see that her jawline was very puffed up and I asked about allergies and the usual suspects but got no sensible answer. She hadn’t been bitten and this phenomenon had occurred when she collapsed and started to fit.

Her Parotid glands were up and her speech was affected by this, although her breathing was normal and there seemed to be no airway compromise. All her vital signs were good and within ten minutes of getting into the ambulance, she began to feel better. Her face became less swollen and her speech improved dramatically. It would appear that her post ictal state and this possibly trigeminal problem went hand-in-hand, although I had thought of Mumps too.


The Welsh God (whoever that is) was obviously grinning down at me because he sent me to a hotel room where a 21 year-old had fallen in the shower and cut her head. I found myself virtually surrounded by Welsh women – every one of them on a weekend Hen trip. Most of them were fully clothed but a few had towels wrapped around them and, I guess, not a lot else. Being the shy person that I am, my eyes had to be averted and so I distracted myself with chit-chat, introduced my Welsh student to them, so they could 'integrate' and checked the tiny little scratch on the woman’s head. She shouldn’t have called an ambulance for this but here I was and I knew that she wasn’t going anywhere but out tonight, so I cancelled everything, including the helicopter that might be sent for her ( head injury), stuck a strip on her cut and bid her a jolly good night out...and not to come anywhere near where I work until I had gone home.


Two patients fell ill at the same time in the same place and I was sent to investigate. Usually we ring our alarm bells when we get these coincidences but obviously the powers that were in Control decided I could catch whatever was being passed around. So, I went and I found an elderly man and a young man, both with their loved ones in hand, sitting looking quite ill in the lounge area of a gallery. The young man was actively vomiting and the older man was very pale; pasty-looking in fact. At first it looked like the same thing was affecting them both but neither knew the other and they had eaten different meals. Their histories were different, of course and they had slightly variable symptoms.

I checked one while N checked the other. I decided one had to wear a mask (the young, vomiting man) and the other didn’t – he was on Beta-blockers and had a slow heart rate, so his meds were probably making him feel ill.

I took the older man in the car and the young man, who became acutely more unwell, went by ambulance. It was a bizarre end to the day and one which N decided was very entertaining.

Be safe.

Monday, 3 August 2009

The flying drunk

Night shift: Ten calls; two assisted-only; one treated on scene; one no patient contact; one hoax and the rest by ambulance.

Stats: 2 eTOH; 1 EP fit; 1 Fall from height; 1 Abdo pain; 1 Headache; 1DOAB; 1 Assault.


There’s nothing pretty about a 20 year-old woman who is slumped in a doorway, drunkenly asleep with a fly-catching gaping mouth and a bottle of wine by her side. The police were just ahead of me and stood back until I had shaken her awake, which only took a moment and almost no effort. The man in the little shop across the street stood in his doorway, shaking his head in disapproval and disgust. He was probably the one who’d called us out on this ‘unconscious woman’ 999 adventure and he knew that she was just worse for wear and unfashionably visible near Bond Street, so had to be removed. This was the job of the emergency services of course because the council don’t have human clean up units. Personally, I’d contribute a few quid in tax to make that happen, then we can go see Mrs Nora Riley when she has her first heart attack.

The drunkard woke up, demanded her dignity back and stormed off, minus her booze, which had been confiscated by the cops. I love a happy ending, don’t you?


I treated the next patient on scene, he was recovering from an epileptic fit at a train station and insisted that he didn’t need to go to hospital, so I got a signature and he got to look after himself at home.


A drunken Estonian man climbed a safety bar 20 feet up on a mezzanine cafĂ© in a busy train station (the same one I’d just visited for the epileptic patient), he teetered around contemplating his next move before deciding that vertical was best. He jumped straight onto the cold stone floor below, landing on his feet and crumpling like a used bag of crisps (chips for my U.S. friends) by all accounts.

I arrived with a crew to find him lying on his back, kind of unconscious but more drunk than unwell. He didn’t have a mark on him but the fall was decent enough to produce ‘invisible’ injuries and a hard landing on the feet can cause compression damage to the spine as well as basal skull fractures (think of all that energy travelling up the spinal column), so he was handled as if he’d been hit by a car – or had jumped from a height…which he had.

HEMS was requested and they arrived by car (they don’t fly at night) and assisted with a more or less finished job; we’d already collared, cannulated and oxygenated him.

This man had the smelliest feet I’ve encountered at close quarters for a long time – if he jumped to get away from the stench, I wasn’t surprised. It was gag-inducing stuff and his long, thick and thoroughly blackened toenails were no advertisement for his country of origin or the pristine condition of our helping white gloves.

The man on the floor had been ‘practising’ his death-defying moves up on that balcony, according to witnesses, and so we became more and more convinced that he had no intention of hurting himself and that he was probably some kind of East European circus gymnast who knew exactly how to fall. He proved our cynicism correct by staging a miraculous recovery and attempting to escape from the ambulance whilst verbally abusing the crew en route to hospital. He was a drunken fool who’d cashed in on our stupidly generous system by a) collecting his free handout in order to get drunk and b) displaying his contempt for this country by charging us even more tax-dosh for ‘healthcare’ and transportation to hospital. He typified the reasons behind our slowly atrophying State-cares-for-all culture and the gathering argument for sensible policing of our delicate financial position. For me, however, he was a waste of time and money for many other reasons and his feet didn’t help his case at all.


No patient contact for the 25 year-old woman with abdo pain who walked out all smiley and drinking a glass of water as the crew prepared to take her to the emergency department.


Then a 30 year-old chef told me ‘I can’t breathe’ as he completed full sentences, explaining that he’d recently had Swine Flu. He was taken to the ambulance with a mask on his face. Well, they do it in hospital so I thought we’d join the drama set on this one.


Another patient whose cause for concern was not being able to do something (in this case ‘I can’t feel my body’), had a headache. Again, like the pig-flu chef, he was at work and the pattern that I have become very familiar with was playing out as normal. Low paid workers have little or no protection when they feel unwell or simply want a day off work. They know they will be sacked but if an ambulance is called and it all seems like a genuine emergency, then they may just have a job to go back to when they have rested for a day or two. So, even though the argument for this so-called ‘black economy’ is that it sustains the country (and I agree with that), ironically, we pay more when hundreds or thousands of these people are taken to hospital on the basis that they cannot ‘take a sickie’ when they feel like it. If we just paid them a fair wage we probably wouldn’t have this new problem (which is growing).

Anyway, this man had nothing but a headache and he could have coped with it but the additional stuff, neurological and serious-sounding to the untrained brain ( he cant feel his body remember) merited an ambulance and a trip to hospital. He walked all the way to the vehicle without any problem whatsoever, incidentally. Oh, and I’m not writing this with gritted teeth or clenched jaw (some of you imagine me like that I think); I’m recording something of the general deterioration of our culture, care system, independence and common sense which has going awry. I look after of me and mine, so I don’t really care if people need to use us like this (unless they abuse us deliberately and spitefully) – it’s a matter of survival for some, and the lack of an emergency response because we are tied up with such social issues, is a gambit on life or death to others which the Government and some fence-sitting socialists will have to account for eventually.


Tonight was the closest to a knock-out blow for me in the job so far. I was called to deal with a huge bear of a man who was collapsed on the floor of a club. He was very drunk and possibly (likely) very stoned out of his skull too. He was intermittently quiet and aggressive, depending on what you said to him. One punch from this guy would have taken most of the people in the room down – I was with a crew and a few security guys and had asked for more because I had given him Narcan to reverse any opiate he may have taken. There were times when he looked like he had stopped breathing but nobody was brave enough to shake him up too much, so he’d surprise us instead with a sudden awakening on his own –like BOO!

The police arrived to help with his ‘removal’ to the ambulance; we all knew he wasn’t going to come quietly or willingly, so their hands were required to assist. And, to be honest, he was as gentle as a very large, bearded, leather-clad, tattooed and chained up lamb as we got him closer to the vehicle but he kicked off a bit when he realised what we were doing. He had to be ‘persuaded’ inside the ambulance by the cops, where he promptly collapsed to the floor. I climbed in to get him to his feet and found myself alone with the task. He pulled himself up with some of my help but I was thrown violently back against the bar across the top cabinets of the ambulance. My head made very hard contact (everyone inside and outside the vehicle heard the crack of my skull) with it as the full weight of his body crashed against me as he sat down. I had a moment of blackness to enjoy and then shook it off but it was very close and I had a flash-nightmare about being sent to hospital in an ambulance myself.

I have to admit that after that incident, I made a few minor driving errors (mainly red traffic lights and the proximity of large vehicles) before I realised that I still hadn’t recovered from the blow to my head, so I went back to the station and rested until the clouds cleared. After that my night shift went swimmingly…


A Drunk on a Bus (DOAB) tested my return to normality. Two young out-of-area female EMTs were gently shaking him and coaxing him to comply and get off the bus. He, of course, wasn’t taking a blind bit of notice and I applied my own technique, which is tried and tested. I shouted ‘Wake up and get off the bus please!’ as I hauled him into an upright position. Don’t worry, he was drunk…he was asleep and he was on the bus. I always check these things before I go bowling in. The new crew have either learned that this part of town is different and there is a particular way of doing things or that I am a very rude paramedic. I didn't hang around to find out.


A running call in Leicester Square next and an Australian man almost got his tooth knocked out by his mate after an argument. The largish bloke was very concerned about the aesthetic damage that had been done and less bothered by the fact that he’d been knocked out cold for a few seconds after the blow had been struck.

Neither he nor his other (less aggressive) friend wanted the cops involved and preferred to sort it out themselves and initially he didn’t want an ambulance but as the horror of his uneven smile dawned on him, he insisted on going to A&E. An ambulance collected him and his friend a few minutes later.

He and his friends were rugby players, so I kind of thought he was behaving like a Hell’s Angels member who’d been scratched by the pet cat and insisting on a plaster when he continually moaned about a bent tooth and then asked for an ambulance.

During this engagement, a young black lad sped past me and attempted to evade the cops for some reason - he even knocked a PCSO about in the escape bid. It took seconds for the world’s combined police forces to descend and catch him as he fled. I don’t know what he did but assaulting the PCSO was a big mistake.


The night ended with a traditional tribute to all those hard-earning decent tax-paying citizens of London town; a hoax call. This one was from a call box (they usually are) and described a man who ‘needs someone to talk to him about where he is’. This was given a Red1 priority – possibly because he’d added the fact that he wasn’t breathing and didn’t have a heart beat, who knows? I was sent to investigate and when I got there I found the usual suspect…an empty phone box. But it was a pretty red one, so that’s ok.

Be safe.

Sunday, 2 August 2009

Plinth life

Night shift: Six calls; one by car, one treated on scene and four by ambulance.

Stats: 1 EP fit; 1 Chest pain; 1 Asthma; 1 Abdo pain; 1 Head injury.


The Student Paramedic (SP) is with me again tonight and we start off with a call to a 28 year-old woman who’s had two fits in the street. One of my MRU colleagues is already there and he explains that she usually only has one seizure. She has a cut to her chin but no other injury. She seems lucid enough and because there are no ambulances available, I decide to take her in the car. If she’d been confused or the least bit unstable, I would have waited with her but Control has sent me for this reason.

We get her to hospital quickly with her friend as Chaperone.


Not long after this I was asked to attend a 70 year-old lady who was unwell. I was told that she just needed a ‘welfare check’ (and for my American friends that means a health check; not a Government handout). We got to the large flat in a well-off part of town and she was sitting in the front room with her sister. They live on their own and have done so all their lives – never been married, never been apart. There used to be three of them (I was shown a picture of them all in their youth) but one of them died recently. It was a poignant tale to hear.

The unwell lady had a ‘heavy chest’, which she had been coping with for a few days – she’d had a cold too and complained about pain down one side of her face every now and again. This sounded like trigeminal neuralgia to me; possibly associated with pressure in her skull, so I dropped the idea of leaving her to it and cancelling the ambulance.

They had apologised profusely for calling us, citing our need to be with ‘genuinely ill people’. I had to smile at the irony of it – here we were with two hard-working, tax-paying people who’d probably never dialled 999 before in their lives and they were feeling guilty about their ‘abuse’ of it when I’ll bet not a mile away from them, someone is making demands of us purely because they can, and not for any truly medical reason.

As the lady was taken out to the ambulance, I noticed a Euro-Millions lottery ticket on a table. I guess even the well-lived have aspirations of more luxury.

Her ECG was abnormal and I was invited, by her sister, to talk to their private GP. I’m always a little wary of doing this because some of them tend to adopt an immediately haughty air about them when they realise they are speaking with a mere ‘ambulance driver’. Fortunately, this one treated me like a fellow professional and we exchanged information about his patient like colleagues.

They were two of the loveliest people I have met in a while and their little history, which adorned the walls and tables of their flat, set in picture frames and trinkets, reminded me of how honoured we are to be invited into the lives of others because we are trusted and appreciated by them. I think much of the harm done by the masses who abuse us and whose lives, forgive me, are just not worth knowing about, is repaired when we deal with genuinely nice people.


Unfortunately, it was back to ‘normal’ on the next call, for a 46 year-old man who had chest pain. In fact, he was in bed, drunk and in no pain whatsoever. His concerned neighbour had called us on his behalf and he lay there refusing to keep his eyes open as the alcohol-induced stupor overtook him. He was just another sleepy drunk, with a long history of being just that and there was no reason for us to be there. We left him to the crew and they did what they had to do. He went to hospital to sleep some more.


A running call in Leicester Square when we got back on stand-by; a Birmingham man, out with his wife on their first anniversary, was feeling a bit wheezy and tight-chested. He is asthmatic and had forgotten to bring his inhaler with him when they left the hotel. He’d approached the car and asked if we could help, so the SP got busy and nebulised him until he felt ‘much better thanks’ and the couple continued their evening (via the hotel and collection of an inhaler).


A 55 year-old female with abdominal pain next. She’d claimed chest pain when the call was made, as many do, and she really over-milked the pain she said she was in. Her retching seemed deliberate and she only referenced her agony when there was someone watching her. Once again, this seemingly cultural behaviour, for the benefit of their families, exhausts me and makes me feel depressed about the mind-set of grown-ups in some sectors of society. She may or may not have had abdominal pain but, for a woman who has children, to claim 10 out of 10 for it, stating that it was worse than giving birth, even though all her vital signs said the opposite (breathing, pulse and BP changes occur in pain), she was definitely going for the sympathy vote from her extended crowd at home.


At 3.30am, we received a call to a market, where someone had been run over by a fork-lift truck. When we arrived, we found an ambulance already on scene. The patient was inside and he had a head injury, caused when he hit the ground after the reversing fork-lift had apparently ‘glanced’ him. The spritely 85 year-old man had been buying flowers (presumably to be sold from a stall) when he was hit.

At first the story seemed to make sense and the fork-lift driver certainly agreed with it all (well, he would – he was the one that had supplied the story in the first place) but the old man couldn’t really remember exactly what had happened and his head injury wasn’t the only problem he had. When he was moved, he complained about leg pain and I found a significant sprain, possibly a fracture, to his ankle and a very swollen, discoloured foot. He could only have sustained that injury if he’d been violently twisted during the fall, or his foot had been run over by the truck. I suspected the latter.

He was put on entonox for the pain and went to hospital giggling and joking with the crew. He was still under the influence of the gas when I saw him next, lying on his bed in a cubicle in the Majors Department, flirting outrageously with the nurses.


During the shift, we wandered across to Trafalgar Square several times and watched the people up on the fourth plinth. To be honest, I’ve seen little up there to inspire me to think of it as a work of art. Most of them seem to just stand and chat on their mobiles, ignoring everyone and everything around them. We watched a representative of the Monster Raving Loony Party bouncing on a Space Hopper while drinking beer, spinning around a post and using a bullhorn to deliver pointless ‘political’ lectures to three people gathered below at small o’clock in the morning.

Earlier on, we’d watched a boring individual do nothing of any interest as a family had a picnic underneath and an artist painted images of the scene which, ironically would now qualify as art outside of the reality of the situation. At night, a shadow is cast on the National Gallery wall by the lights shining on the people on the plinth. It’s often much more entertaining to watch the shadow than it is to watch the ‘art’.

So, what would you do if you were up on that plinth for an hour? Let’s see what kind of imagination you have. Have fun but keep it clean if possible... remember that kids read this!

Be safe.

Saturday, 1 August 2009

Seagulls at dawn

Night shift: Seven calls; all by ambulance.

Stats: 1 Fractured foot; 2 Faint; 3 eTOH; 1 Normal labour.


I was waved down by a manic Norwegian windmill as I poodled along Piccadilly, so I stopped and the man tried to push a large hopping woman into the back of the car. I wasn’t having that, so I asked him to desist (well, that wasn’t quite the word I used) and questioned him about his actions.

He’d called an ambulance for his wife (the hopping woman) after a heavy shop sign had tumbled onto her foot, making it swell like a whale’s penis (not that I’ve seen one). I called it in as a ‘running call’ so that I didn’t get caught with a Red1, drunken emergency in the middle of this tourist crisis and an ambulance snaked its way around the traffic to reach us.

The woman’s foot had been given some treatment using a bag of frozen prawns and I knew I couldn’t help what I was going to ask next (and neither, I daresay, can you).

‘Are they Norwegian prawns?’

‘Yes, of course’, replied the man as his family giggled in the background.

The man’s son had run down to the local shop to buy them and had slapped the pack on her injured extremity to keep the swelling under control – a wise and educated move; one which very few of my Brit (or pseudo-Brit) patients would have bothered to try before dialling 999 in a panic.

‘They cost a lot!’ the man’s son went on to say. Yeah, in Norway they are cheaper because they are caught on the doorstep. Bring them over here and they go up in price – it’s therefore less expensive to break your foot in Norway, right?

Anyway, she hopped into the ambulance (which she didn’t need to be honest; they’d waited long enough for a cab to A&E) and I got on with my night.


My next patient sat on her sofa holding on to a jug of what looked like pastry mix but which was in fact her own vomit. The 53 year-old lady had passed out earlier, so her daughter called an ambulance. She didn’t look well at all – very pale and sweaty with obvious SOB. Her sats and BP were a bit rubbish (in fact her sats were so low that I didn’t believe my probe; it becomes inaccurate when the battery is going).

She’d been vomiting for a while and, because she was diabetic, I thought the answer might lie there but it didn’t – her BM was normal. She’d also suffered a recent ongoing headache and this made me wonder about other possibilities, including a subarachnoid.

Her husband is disabled due to recent strokes, so she was very reticent about leaving him to go to hospital but her condition merited the trip and I was concerned that she may deteriorate – I’ve seen it too many times before.

When the crew arrived, we got her down to the ambulance and confirmed that her sats were indeed low, so she got more oxygen. As we were loading her, a woman from another block of flats asked if someone could help her with her disabled son, who had cut himself, so one of my colleagues went up to see him as we continued our care of the lady in the back. When she’d finished (dressing applied and advice to go to A&E given) we took the patient to hospital.

It was just about then when I received a text telling me that the young woman whose throat had been cut the night before had died in Resus. I couldn’t believe it and felt utterly numb. I cope very well with people who are dead or dying and there’s inevitability about it but I find it hard to reason out the loss of a life when it had been delivered alive to definitive care. She was only 22 and it had been an accident, I thought, over and over again.

When we got to hospital with the patient and after the handover had been carried out, I asked one of the nurses who’d been on duty when I brought the cut-throat girl in – he told me that she’d gone up to Intensive Care and that she was ‘doing well’. I’d been caught out, yet again, by the mis-communication brought about by rumour after a serious job. It’s common enough; other crews talk about it and then it becomes a matter of different stories from different people – especially when the outcome is discussed. I was relieved and so, I guess, are you!


Some of the poshest restaurants in town are also the hardest to find. They have little signs and well hidden road numbers, if they have them at all. I guess they think they have some kind of exclusivity if they appear to be discreet but for us it’s a nightmare, so the call to a 60 year-old man who’d collapsed in one of these places meant I was three minutes late getting there – the name plate was so small you’d need binoculars to eat there.

Inside the restaurant, the toilets were even more pretentious; small egg-shaped capsules in which males and females could secrete themselves and their bodily waste while looking chic and modern about it. I know this because the patient was sitting on a stool in the middle of these things as pretty people went about their ablutions – not the best environment for a sick man.

He’d been feeling unwell and had collapsed a little earlier. He didn’t want to go to hospital and I was tempted to oblige and leave him to it after his obs looked normal and he said he felt better but he had a history of kidney stones and he still didn’t look well, so when the ambulance arrived I sat with him as his BP was measured again and again – it dropped considerably several times, so he was taken in urgently – something wasn’t right.


I was told that my ‘attitude’ wasn’t good enough when a young Asian student, a friend of the patient I’d been called to, who was drunk and had fallen, cutting his face in the process, took exception to the way I said ‘So, he fell because he’s drunk and he cut his face just as you would if you fell normally and you felt the need to call an ambulance?’ To me it was a straight-forward question.

The man on the ground had a tiny cut to his cheek and he could stand and stagger if made to (proven when he was taken to the ambulance). This had been given a Red1 category because someone had said he wasn’t breathing. Someone (I dare not suggest who) had simply panicked. We are the result of knee-jerk reactions to alcohol-induced confusion.

All of the men around me were students; medical students I may add and their combined intelligence should have counted for something but this young man ranted about what I’d said as if it were the world’s biggest incriminating statement. In a way it was; it incriminated their lack of common sense and he didn’t like that one bit.

Meanwhile, his drunken friend refused to get into the ambulance and wasn’t interested in help anyway, so the crew had to spend a good deal of time coaxing him to behave.


A long and hard job later on involving a large 30 year-old man who’d collapsed in the basement of an hotel in the cheap end of town. He’d vomited all over his face and the floor; you could smell it from the top of the steps – it was the thick stuff, like porridge and it was playing havoc with his airway, so I scooped it out of there first.

His mates, who had no idea how he managed to get down there from the third floor, swore to me that he’d only had 4 pints. I reckoned that, given his large frame, this guy could tolerate much more than that before he got into such a mess. He was barely conscious. There must be another reason for him to be so wasted. He may have taken drugs but that was denied vehemently by his mates or he could have fallen and banged his head on those steps. If he had a head injury, it was internal because there was no visible sign of it.

The crew arrived and we spent the best part of thirty minutes trying to figure out how to move him safely. He was aggressive and combatant when we tried to life him and his position in the corner meant that we were crouching just to get a hold of him. He was sixteen stones of dead weight and our backs weren’t happy.

I put a line up in the hope that the fluid would wake him up a bit but it didn’t and we were left with no choice but to wrap him in a blanket, so that his arms and legs couldn’t flail, then drag him to the chair and carry him up three or four of the most awkward sets of steps you can imagine. This hotel was in a bad state of disrepair and the convoluting corridors and stairwells made emergency rescue almost impossible. I dread to think what would happen if there was a fire in there or if someone had a cardiac arrest in that bloody basement.

We took the man to Resus because I was unsure of his problem. I hoped they’d find a good reason for their time, such as a head injury that could be fixed or something... anything that would deserve a bed in that department but, I found out later on, he was just very, very drunk. It turns out his mates had lied repeatedly – he’d been downing shots all night and was poisoned out of his skull. In fact, when he woke up he demanded compensation for his shirt, which had to be cut from him. The nurse asked him if he was prepared to compensate for the vomit-stained uniforms of the paramedics that had helped him. He declined and went home with a tucked tail.

I’d rather ‘blue’ a call in and get it wrong than put someone’s life at risk by not doing so. In that respect I feel vindicated.


Next up, a Maternataxi job for a 21 year-old whose contractions were 5 minutes apart but whose waters had not yet broken. She could have gone in a cab but I’m guessing they didn’t have a car and 999 was their preferred option because pregnancy is such a problem these days and is rarely normal, right? I remember well the midwife who once said to a patient I’d taken in by ambulance ‘You’ve had none months to save up for a taxi’.


I’d watched a young black man (gangsta-type) with a metal-tipped brolly causing trouble in Leicester Square in the early hours. I remember thinking that he didn’t have that umbrella for rain as he wielded it around dangerously while his little gang looked on, suitably impressed. Then I met him later on when he called 999 for one of his friends who was now slumped on the street, drunk, with fag-ash on his chest. As I turned the car around to get to him, the brolly-wielding man shouted abuse at me, thinking that I was leaving them there. He probably thought that as they were all young black men, I’d decided not to bother... this in itself is a form of racism. I have no qualms whatsoever about the colour of someone’s skin. I don’t care to be honest.

His mate was in no need of my help and pushed me away at every attempt to start my obs. He got a cigarette out and puffed away quite happily and his crew watched as I became redundant. You see, we are simply pawns of the NHS and we do as we are told to do.

One obese white girl in the gang stuttered verbal rubbish at me as she chomped (ironically I think) on a bowl of salad. Then she looked up suddenly and shouted, as if some magical thing had happened, ‘Oh look. A seagull!’

Be safe.