Friday, 26 February 2010

Full moon madness

Night shift: Twelve calls; two declined; one assisted-only; three treated on scene; one by car; five by ambulance.

Stats: 2 Faints; 1 Fall (eTOH); 1 eTOH; 1 Chest pain; 3 Head injuries; 1 Hyperventilation; 1 Glass in foot; 1 Facial injuries (assault); 1 Blocked catheter.

I came in tonight and was told our HQ had been under attack from knife-wielding Gangsta-types who had spilled in through security during a fight which raged in the street. At least our Control colleagues got to see what we have to deal with out here at times.

A 71 year-old man collapsed in a theatre and this is not unusual in London’s old and very hot auditoriums – we get calls like this almost every day. This time, however, I was told he’d fainted twice before and although no cause had been identified after a barrage of medical tests, his pulse was too slow for his age (around 56bpm on average). His ECG and other readings were normal... it was just that slow pulse that bugged me.

I was sent an Urgent Care crew, despite asking them not to send anything yet until I’d checked the man out properly, and I used the opportunity to spend more time checking his vital signs and looking at his pulse rate to see if it would recover. After almost an hour with him, the rate hadn’t really changed much... it was nearer 60 than 50 but it still wasn’t right. He, however said he felt better and didn’t want to go to hospital, so after my usual three attempts, I gave up and he got a full report to take to his doctor on Monday.

I told him I was from Glasgow and he asked me the same standard question that everyone who is not from Glasgow asks... ‘are you Celtic or Rangers?’

Wolfe-Parkinson-White Syndrome can be fatal if not taken seriously, so my next patient, a 28 year-old woman suffering this condition who fainted in a restaurant got more of a priority response from me than she did from the staff who’d called after she fainted, recovered and felt like passing out again. Of course people faint all the time but here was a patient with a reason behind it and the possibility of deterioration or even sudden death, although unlikely.

I spent a while with her and her husband and got to know her history – she’d had two ablation treatments carried out and it’s possible they hadn’t been completely successful. It was equally possible that something else, something entirely benign, had made her faint. I wasn’t prepared to take the risk and I got her to hospital as soon as possible.

A fallen 49 year-old, who’d attracted the help of a few concerned MOPs, including a St. John Ambulance volunteer who just happened to be in the area, was drunk and nothing more. He reeked of booze and stale cigarettes but denied it of course. No wonder he fell on the pavement.

He had no injuries but got a Red response for a ‘head injury’ that didn’t exist. He got an ambulance of course.

Another non-runner who got an ambulance and a Red category was the 20 year-old man who fell asleep on the pavement at a bus stop. His can of Stella, which was rolling around him as he slumbered, was the give-away but it still didn’t stop the decent, honest, hard-working MOPs from dialling 999 and stating that he was ‘passed out’.

When I got there he was sitting up and the two female MOPs who’d called sheepishly informed me that he was 'awake now’. That I could see and further investigation revealed that he was also drunk, on drugs (‘I had a bit of weed’), on the streets and not interested in going to hospital. As interested in fact as the hospital would have been to receive him – they were extremely busy tonight.

So, after checking him out in the ambulance, I bundled him into my car, drove him to a quieter place, gave him a blanket and set him down in a doorway where I knew he wouldn’t be disturbed all night as he slept. He was very grateful.

One swiftly after the other when I am sent up to Charing Cross Road, which is already filling with ambulances and police for other incidents - for a 20 year-old man ‘having a heart attack’. An unlikely call given the nature of tonight’s Reds and this one joined the others as a wasted run. He was lying on the ground, with police officers and his mates around him. He was on anti-depressants and had a history of SVT but his pulse was regular and not at all tachy. He wouldn’t speak to me at first and had been the same with the police – this is not the behaviour of someone who is having a heart attack. He just didn’t want to talk.

The crew arrived as I was finally getting through to him and he told me he had chest pain, so of course that will be taken seriously now but he is known to the crew and they have had this from him before apparently.

Meanwhile, just up the road a man has fallen and now has a head injury and I’m asked on the radio if, when I’m free, I can go and attend to that call. I free myself up as soon as the crew have taken over with my chest pain man and walk up the 30 or so metres to the bar where the man fell. The police come with me because they haven’t received any calls about it and they’re curious. It’s also good protection for me because the crowd is getting ugly.

The man is sitting on a wall outside the bar and the doorman tells me he is okay and wants to go home. He has a minor cut to his forehead and is blind drunk, so no wonder he fell. I ask the man if he wants to go to hospital (guess how many times I ask) but he just wants a cab, so me and the two cops leave him to it.

A call to Leicester Square for a female who was having an asthma attack turned out to be a drunken woman who was hyperventilating and whose friends were frantically searching for a paper bag and had come up with a handful of dodgy newspaper from the pavement as an alternative. This call was routine and nothing at all but an ambulance trundled up and she was taken into the back of it to rest 'til she calmed down. While she did that, I was asked by a police officer to check on a girl at the north end of the square and I made my way up there to find a very, very drunken 19 year-old Bulgarian girl with her friends. She had fallen three times onto her head and now had a nasty swollen lump over her eye. Her mates swore that she didn’t drink but she was drunk on something because her behaviour was outrageous.

Head injuries can produce varying behaviour, including combativeness and I was very concerned that this young woman was in trouble. She certainly wasn’t coming with me in the car and her friends turned out to be a real handful too, as the cops around me struggled to keep them in line.

A fight broke out not far from me and a man turned up with a head injury and a cop in tow. His injuries looked severe enough to merit a trip to hospital and now I had this misbehaving Bulgarian girl and a recently beaten up 18 year-old man to deal with simultaneously. It was a tricky balance and I asked Control to send me two ambulances – an act I felt would have me condemned for the rest of the shift. Still, neither of them could travel with me and they couldn’t go together in the same vehicle.

The Bulgarian kicked off with a female police officer as she sat in my car waiting for the ambulance to arrive and had to be restrained a little, such was the madness of her attitude. Again, I think the head injury had a lot to do with that.

When the ambulances showed up, the head injuries were put in their appropriate place and I checked back on both. Hungarian girl had calmed down and thanked me with a long, tight hug and cheek kisses that were beginning to feel uncomfortable because I couldn’t break her grip (I must be getting old). The assaulted man now had thoracic spinal pain and I found a pattern bruise over the area of his back where he felt discomfort. Someone had put the boot in there (as they had done with his head), so he was collared and boarded. Doing the same with Bulgarian girl would have been impossible, even though she could have done with it as a precaution – she was far too feisty and I now knew that her hug-grip was Olympian, so there’d be no attempt at being silly.

As I cleared the paperwork for those calls, I received another and was on my way to a police station, inside which was a 29 year-old female and her boyfriend, along with two police officers. She’d been running away from someone who was threatening them after a bust-up outside a club and, in order to flee faster and more efficiently, she’d removed her high heeled shoes. This meant she was running barefoot and somehow she managed to run across broken glass in the street. What are the chances, eh?

As she gave her harrowing (ish) account of what had happened to the officer, I examined her foot – I gave it a good wipe down and then saw the problem – she had a sliver of glass embedded in the sole of her foot, right in the middle. I called off the ambulance and removed the offending glass while she winced and talked at the same time; quite a trick.

Now that the glass was out I checked the rest of her foot again and confirmed that all was well. But no, wait a minute, she still had some discomfort. When I pressed on the pad of her sole below the big toe, she said she felt something sharp inside the skin. I looked at it again and broke news to her that would probably embarrass her for a while to come. ‘That’s just a verucca’, I said... medically.

An alleged robbery-assault that resulted in a 29 year-old Irishman being beaten up and left with facial injuries, led me to the drizzly street where police were interviewing him and he was steadfastly refusing medical attention. I managed to befriend him enough to clean his wounds, which were minor to be honest, and he was passive enough, but when the officers asked him about who’d allegedly robbed him again he did something quite comical – he said ‘she took my wallet’. Now he’d been saying that a bunch of blokes had removed his wallet, taken nearly £500 in cash (do people really carry that much around on a night out?) and then thrown his credit card, and the empty wallet, back at him once he’d been soundly beaten.

She?’ said the very cynical police office who’d just asked me to travel back to the police station with him and an accompanying officer because they had no vehicles to do it.

‘Yeah, it was girl that robbed me’, he said unconvincingly.

I watched the police officer’s face harden and he turned to me and said, ‘I won’t take up any more of your time, thank you anyway’. That was code for ‘we are going to have another chat with this idiot, so you are free to take another call... something more important perhaps’. Then another fight started down the road and I got in my car and slunk away towards coffee if I could find it.

Later I was asked to ‘sign off’ an Urgent Care crew that was dealing with an 80 year-old man who’d fallen and cried out, causing a neighbour so much concern that she called an ambulance. The man’s daughter arrived and was able to explain that his urinal catheter hadn’t been changed for three months and so that was probably the problem. Sure enough, the old man was complaining of burning pain at the catheter site and a district nurse was called out to deal with it. I signed the PRF off and left them all to it....

...Until I went back to collect the ECG/defib they’d left behind.

Be safe.

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