Thursday, 14 January 2010

Emergency chin

Icebergs in the water on Trafalgar Square.

Day shift: Three calls: Two by car and one by ambulance.

Stats: 1 ?TIA; 1 Deep cut; 1 Assault.

Back on the car to watch the rain melt any remaining snow as the weather became a little less cold, giving us a respite from the fall-fracture and associated calls that have plagued the service over the past week.

It was a long time before I received my first call of the shift – it was lunch time in fact. I went to check on a 66 year-old man who’d developed left-sided numbness in his arm and leg. He had no medical history of any significance and he was able to walk, talk and complain about the number of times he had to repeat the story of his current problem. I apologised for being the one asking him for the fourth time and explained that I didn’t know it, so needed to hear it for myself. I thought about the earful the poor doctor was about to get for being the fifth person in line.

He lived with a disabled woman he called his 'friend' in a cluttered flat with the largest portable commode I’ve ever seen. She, to be fair, was a wide lady and the device was required because she was unable to move much – still the size of it had me staring for a few seconds. At times I was tempted to place bits and pieces on it, like my BP cuff and BM kit but remembered what it was used for and resisted to the point where I would be looking around the room for a tidy space that didn’t receive human waste on a daily basis. I settled for the floor.

The man rode quietly in the back of the car and was deposited in a cubicle to await irritating person number five, who would no doubt find something minor wrong with him – or he had suffered a TIA and would recover fully.

Later in the afternoon, after I’d been watching the ice melt on the Trafalgar Square fountains, a call came in for a 35 year-old man in a police cell who had a cut to his chin but was ‘bleeding seriously’. Now, I wasn’t sure how to take this one and I let my imagination run wild in supposition (maybe he’d impaled himself on something nasty) as I drove to the police station. Once in the Custody Suite (the police hotel), the nurse explained that the man, who was being guarded by five large cops as he sat in his cell, had been bleeding for four hours because he simply refused to have anyone dress it. He’d been to hospital and a doctor had stopped the bleeding for a short time but as soon as he was being returned to his cell he tore off the dressing and the cut bled even more aggressively. When I finally got to meet the patient I was shocked to see just how much he’d bled from what turned out to be a 4cm laceration under his chin. Drip, drip, drip it went onto his white clothing (worn as his religion demanded), soaking through and making it heavy. It was covered in large clots which had been created by the sheer accumulation of blood. His head, face, hands and feet were crimson. Nothing had escaped the staining – the cell door was smeared with it and the toilet bowl contained a pool of it. It was like walking into an abattoir.

I managed to make the man see sense after his initial resistance to go anywhere but home. ‘This is nothing’, he said unconvincingly. Only when I got him to really look at the amount of blood he’d lost (and don’t forget he’d been bleeding elsewhere for hours before this) did his face register the possibility that he might need urgent hospital attention. I haven’t yet seen someone die of shock as a result of bleeding from their chin and it would be another hour at least before he’d lost enough to make hypovolaemia an issue but he had seemed adamant about leaving it to leak all over the place. Now, at last, I’d gotten through to him and he was pressing a large dressing onto the wound – the pad soaked through in minutes and had to be replaced several times before the ambulance crew arrived to take him, escorted by four police officers, to A&E for stitches.

I watched as the five foot nothing man was taken out of the cell and into the ambulance and I noticed that he was more responsive to the male crew member than the female attendant – this may have been cultural because he’d also been a pain with the female nurse at the station. Of course, male or female, he didn’t like any of the cops.

I’d had a quiet day and was due to go home early anyway because I’d had no break (ironically) but the most irritating thing happened just as my last hour of work elapsed – I got an awkward, time-consuming call – Sod and his law.

A 30ish-year old man had been found wandering into the main road by police and when questioned had not responded – he seemed confused and edgy and had bruising to his face, cuts to his ear and an obviously fractured hand. A cycle responder colleague was already on scene and had requested me to have a look and take him to hospital – if they could catch him again, that is. By the time I showed up he’d legged it and the police were tracking him down, so I stood at a busy junction and chatted with my colleague about the patient.

Nothing was known about him except that he had been injured, possibly assaulted and that he was homeless. After ten minutes, he was brought back to us with three police officers (two plain clothed). He was a six foot plus dark-skinned man with a vacant stare. I asked him over and over again if he wanted to go to hospital and examined his hugely puffed up hand. He didn’t respond to me and he had a passive interest in his injury, so I asked the officers to get him into the car for the trip to A&E.

At first he was compliant but then he wanted out of the car and refused to go to hospital. I asked him a few pertinent questions to establish capacity but he either couldn’t or didn’t want to answer, so I had only two options – let him go and he might wander into the road and be killed or fall down dead because his head injury was severe... or ask the officers to section him under the Mental Health Act to enable me to take him against his will but for his own protection. Now this decision is always tricky and I waited until I’d driven him and the officers to hospital before I asked for the Act to be invoked. Until then he was convinced to stay in the car by the police with the capacity argument in our favour.

When we got to A&E he tried to walk away and repeatedly refused to go into the department. I asked a nurse to come out and see if she could sweet-talk him inside but that didn’t work too well and there was no choice but to use Section 136 to enforce his protection. So, the cops gently but firmly walked the man into A&E and the first available cubicle. Only then did the facts of his situation start to come out as the officers received new information over their radios. Allegedly the man had attempted to steal someone’s mobile phone and had gotten himself beaten up for his trouble. His reluctance to accept medical help was probably down to his guilt rather than a lack of ability to understand the consequences of his refusals and the time and energy that had been wasted trying to persuade him to get treatment for his injuries could have been spent on me and the cops driving to our respective homes, so I was a little annoyed with him.

Be safe.

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