Wednesday, 28 April 2010

Dancing with buses (and JCB's)

Day shift: Five calls; two by car; one treated on scene; one refused; one assisted-only.

Stats: 1 Leg injury; 1 diabetic hypo; 1 abdo pain; 1 RTC; 1 head injury.

A slow start to the day but it was moved along by a 27 year-old scaffolder who suffered an injury at work. While dismantling a scaffold, one of the tubes dropped, bounced on the road and struck his leg, opening it up to the bone around his shin. It didn’t bleed at all, so there was no damage to large blood vessels and the bone looked intact when I inspected it, so he was going to need no more than a clean up and stitches to close it. His boss was unsympathetic on the phone when he called him up to explain what had happened and he banned his friend from travelling with him. Not only that, he told the patient he wasn’t getting paid for the day. I found this rather heartless, especially as the boss didn’t have a qualified first aider on site and the poor guy was left sitting on the pavement with his wound open to the elements.

A diabetic at work who experienced a hypo, with a BM of 2.7, was recovering after having eaten mints, courtesy of his work colleagues. The 37 year-old didn’t want or need to go to hospital, so I got him some chocolate and monitored the rise of his BM to a decent level before leaving him in the care of his friends, more chocolate and a sandwich. Now I was hungry...

But the next call doused my appetite. I was off to the tax office to help a 44 year-old civil servant (probably my tax inspector) with acute onset abdominal pain. She had no medical history but was on her period, although she told me it was a much more intense pain than normal. I took her and a work colleague in the car and, of course, they were both perfectly nice people. It’s the whole taxes thing that gets to us all, not necessarily the people doing the job.

A Red call that came to nothing was for a cyclist who was attempting to ride between a moving bus and a moving JCB when he got trapped and knocked off his bike. He was okay and so was his bike until, allegedly, the bus driver gave the ‘thumbs up’ for the JCB man to move his vehicle again. This resulted in a panicked shout from the cyclist, who was still jammed between them, and his bike’s front wheel was instantly crushed. The patient, a 34 year-old man, wasn’t – he was lucky.

Another FRU was just ahead of me and an ambulance arrived to check the man out but he wasn’t interested and tore off the BP cuff and Sats probe. He was incensed about his bike. Rightly so I think because it looked expensive. Which just goes to show that life is cheap... bicycles are not. Apparently.

Off to one of the better class of department stores in town for a 62 year-old Spanish lady who took a tumble down carpeted stairs and bumped her head when she landed. She also took her friend with her, which proves just how bonded friends can be. The other lady got herself a bruised elbow. All in all the injury on my patient’s head was extremely minor but she gave me something to be concerned about initially because she had red eyeballs. ‘It’s okay’, she told me. ‘I have an eye virus’. Thank goodness, I thought.

She didn’t want to go to hospital and I got her to sign my paperwork after doing the traditional zillion checks to ensure she’d be okay to leave on scene. She wanted to carry on shopping with her mates (one of whom was celebrating a birthday). I wished them luck and made my merry way back to base and on to home.

Be safe.

Sunday, 25 April 2010

Duty of care

As you know I work on the Clinical Support Desk and most of the time I'm advising and supporting crews and other staff with issues that need resolved or clarified. Sometimes the decisions we make on the desk are tough and necessary but it improves me as a paramedic. It's also opened my eyes to the difficulties faced by my colleagues in Control; calltakers talking hysterical parents through the resus of their babies; stabbing victims who lose consciousness while talking to them and angry, awkward and abusive people who just want to insult and denigrate them. Hats off to the lot of you on the 9's.

I've also learned how difficult it can be to persuade someone with a minor problem to take care of themselves or to find another pathway for care when ambulances are in short supply or are engaged on life-threatening calls and really can't be diverted to their 'sore foot' call. In fact, it would be easier to sell a leg of lamb to a vegetarian than it would be to talk some people into growing up and considering taking responsibility for themselves and this is one of the biggest problems we have as a society.

Our duty of care begins when you call us and say 'I need an ambulance'. We are duty-bound to send one if you insist, even though someone else's mum is having a heart attack and might need that same crew in a few minutes as they trundle towards your 'boil on bum' call. Yes, your breathing may not be 'normal' because you have a boil and it hurts but you will NOT die. Someone's mum WILL die of that heart attack.

What about your duty of care for yourself? Why don't you consider the possibility that you could get a taxi to A&E, call an out of hours doctor or make an appointment for an in-hours doctor? What about a walk-in centre or Minor Injuries Unit, emergency dentist or vet, where applicable, for that matter?

There are lots of complex social and psychological issues surrounding certain calls I know, but we are neither a Social Services or Psychiatric tool - we are an accident and emergency service and while we remain steadfastly committed to sending you an ambulance simply because we don't want to make a mistake, the cost to us all is rising annually and the risk to people in real need rises with it.

I'm going to vote on 6th May, like most of you and I can tell you right now that I won't be touching the two main political parties because they are spineless, often lie and (as we all now know) frequently cheat us out of our hard-earned taxes by stealing it through expenses, giving it away to various 'fringe' organisations and individuals who really shouldn't get it or squander it needlessly on pointless campaigns and exercises designed to keep us all quiet while the economy dies and our poor and suffering people go without. Governments have a duty of care too - they are supposed to do what WE ask of them - not what a few minorities wish or demand.

I watched Nick Clegg talk his way through a TV debate that changed the face of the current polls - he was impressive but he still had lies under his rhetoric - he didn't answer every question fully (they never do). I've also seen UKIP's policies and their bold statement 'rights for the innocent, no rights for criminals' and I agree with that. I am NOT liberal minded I'm afraid. I think that if someone steals from you or kills your brother, their rights should be totally suspended and they should pay an equal price. If one person in a gang stabs someone, the whole gang should be punished equally. As I said, it's a bold statement but will never become a reality because we lack the backbone to do it. Too many people will argue, using clever language and laws of convenience, that it would go wrong or that all men (and women) are equal, regardless. I see very little equality as it is.

The Tories tell us they will give us back the power to change things; to sack our MP's and to run our local affairs - I thought we had that right anyway, now it's a gift from them? They want parents to be able to run their own schools and to sack the head teacher if they feel like it. What? I want my kid to go to school and do as he is bloody well told! I want qualified teachers and a head teacher to do that for his own good. I don't want a little gang of twisted parents to influence my son's education and upbringing.

Similarly, I want to be able to do my job for the benefit of the patient. I don't expect to be told how to do it because it might upset a few people. Most of all I'd like to see people decide for themselves that their cut lip, or finger splinter or minor nose bleed does NOT require an ambulance and that they can deal with it themselves.

I'm willing to bet that, statistically, the number of people that die as the result of 999 abuse is greater than the number who would die as the result of the odd error in judgment made when deciding NOT to send an ambulance. Nobody has the guts to try it out though, so we will never know.

The NHS ambulance services, in my opinion, are second to none and the people working behind the scenes and on scene are generally dedicated and professional and only there for the benefit of genuine patients. The same applies to teachers - they exist to educate your child. In a few instances there will be problems and errors but attempting to cover every base by not taking on the duty of care mantle and passing it along to others is futile. The whole health and safety culture works like that, as does the growing greedy litigation thing. If you slip and fall at work because you weren't looking where you were going, is that necessarily someone else's fault?

A duty of care exists as soon as you call us but it remains with YOU until you pick up that phone and dial those 9's. Think about other people before you do; consider a more appropriate pathway for your condition. Don't lie in a pool of your own blood and worry about calling an ambulance because you need us! Get yourself drunk and incapable, however, and then blame a 'spiked' drink or the weather and you are being wholly irresponsible. You had a duty of care to yourself when you left the house to begin that drunken binge.


Wednesday, 21 April 2010

Pass it on

Night shift: Seven calls; two by car; one assisted-only; one left on scene; one home by tax; one taken by police; one by ambulance.

Stats: 1 Chest pain; 1 Multiple casualty incident (D&V); 1 DOAB; 1 Fracture/dislocation; 2 eTOH; 1 Dislocation.

The cough’s a wee bit better and the throat isn’t burning me anymore, so hopefully that’s a good thing. However, I left my wallet, and that means my cash or any means of getting cash, at home as I mad-dashed out to work again tonight. Normally this would simply mean going without chocolate but I was running out of fuel and I knew that I needed to put more into my tank if I was to make the round trip to and from the station. So, after my shift I will attempt to get home on air.

I guess they were trying to make up for last night because I didn’t get a call until 10pm. A 75 year-old man on Chemotherapy and with an old history of MI had acute chest pain, especially on inspiration and I found diminished breath sounds in the left lower field. His ECG showed LBBB and RSR complexes with a Left side deviation in leads I and II. This all amounted to a possible PE (although I would have expected to see RBBB and right deviation) and that’s what the crew agreed on too, so off he went... on blues.

A minor (major) incident later on when I was asked to support a multi-casualty call over in the west, way out of my area. They needed another paramedic to give fluids to children who had taken ill suddenly at a cheap tourist hotel. Ten of them had diarrhoea and vomiting and this suggested a pathogen was being passed from one to the other. None of the patients was connected as a group and so it was suspected that food may have been the source... or the Norovirus, which I am just getting over myself after contracting it from a patient a few weeks ago.

The police were on scene to ensure nobody entered or left the premises until a thorough investigation had been carried out by HART and the LAS doctor. Inside, teenagers from France and Spain were taking photographs of the scene outside in the street, where four ambulances, as many FRUs, police and HART vehicles were parked up in readiness for something major but all the patients were eventually allowed to go back to the Hotel by the doctor. Those that had been taken to hospital were returned in case they spread the infection even further.

A DOAB next and this one came in as I left the west, so I was glad of it as it got me back to where I belonged. The man was, of course, just asleep on the bus after a heavy drinking session and it took a minute to get him off and walking away, although he did stagger into the road with his eyes shut and that caused a bit of a commotion. ‘I’m alright, bruv’, he said as I grabbed his collar and led him out of the way of traffic. Yeah, of course you are.

A nasty fracture dislocation of the small finger next when a 31 year-old amputee tripped while attempting to clean his stump and fell hard onto the floor, bending the finger back so hard that the bone sheared through the skin and the joint came apart. The poor man had already lost a leg as the result of a road traffic incident and now he was facing the prospect of losing a digit but I reassured him – as long as the phalanx has blood flowing through it (and it did), then it should be fairly easy to repair. I took him and his mum in the car to hospital.

I felt like no more than a servant to the well-off drunk on this next call. A 25 year-old woman slumped on the lap of her friend outside a posh club. She’d drunk a bottle of wine (or two) and had been sick once on the pavement but because she was making the place look bad, an ambulance was called on the basis that she was ‘very cold’. I got no response from her as she lay there with her vomit-stained hair and when I tried to take her temperature she behaved like a child at the dentist. Her friend was cooing and fawning over her without considering what else I might best be doing with my time and skills (like saving someone who is in cardiac arrest). Neither of them had any inclination of how serious their stupidity might be – the consequences hadn’t even crossed their minds.

I left her to a taxi home with her friend when she sat up and lucidly complained, while giggling, that she had cramp. Some things just drive you to consider saying something that would lose you a profession.

A 19 year-old girl with a dislocated knee and an over-amorous boyfriend sat in the back of my car on the way to hospital after I’d reduced the problem and wrapped it for x-ray. I had to tell her man to settle down because I wasn’t a taxi - he was all over her and at one point his head seemed to disappear from my rear view mirror. She dislocated it when she was dancing with him in a club. She had years of history with this knee and it wasn’t the first time she’d knocked it out of position.

The police took my next patient, with whom I had no contact, because she was drunk but capable. They arranged a taxi for her and I was cancelled on scene by them.

Be safe.

Tuesday, 20 April 2010

ECG not-so-easy

Night shift: Six calls; one false alarm; one NPC; one by car; three by ambulance.

Stats: 1 Fire incident; 1 EP fit; 1 Head injury; 1 RTC; 1 Chest pain.

Fire calls are becoming more common and some of them involve multiple casualties – a few of which don’t make it. My fire call tonight mentioned ‘multiple victims’ but it turned out to be a small fire that had taken hold on the roof of the bin shed of a block of flats. Somebody up in the heights smokes and then drops his/her/its lit cigarette butts onto this roof. When enough of them accumulate, a small fire erupts, causing panic with the residents and the LFB to trundle out. I was on scene with a crew and we were effectively cancelled as soon as we arrived – no persons reported in fact.

As I completed the paperwork I was asked to go a mile further to a faint that in fact turned out to be an epileptic girl having a fit. She was post ictal when I arrived – recovering slowly but in danger of having another seizure, so when the crew got to us we took her down to the ambulance fairly quickly. She had a minor scalp wound which had been caused by the hard wooden floor she’d fallen onto. She was a diagnosed epileptic but her GP had weaned her off her medicine a few years earlier.

You’ll see a lot of head injuries in my stats but don’t be alarmed because most of them – around 95% of them (if you wish to trawl through every case and substantiate that statistic, feel free) are nothing more than little cuts that need closing with paper sutures or a dressing applied. This stuff could walk out of the house and walk itself to the nearest Minor Injuries Unit or A&E reception. Unless they’ve been knocked out or there is another significant complication, a 999 ambulance call is a dramatic and unnecessary thing to make. This includes children.

My next patient was a 20 year-old man who bumped his head on a wall and cut his forehead open. There was a good dressing in place but, for some reason, an emergency call was made and I travelled a long way south to deal with it. He went in the car and the nurse ‘tutted’ loudly in her head when I handed him over.

An RTC next and a 45 year-old cyclist was knocked off his bike and left in the road with a broken cheekbone by a lorry driver who either didn’t see him or didn’t want to because he continued to drive away from the scene. A doctor and nurse were coincidentally nearby so he had good company until I arrived. I made use of them obviously, for neck control and general stuff while I requested police and an ambulance. The man had been thrown over his handlebars and landed on his face. He had no memory of the incident but appeared to have that single injury and nothing else. Cyclists in London risk their lives every day and no amount of TV preaching about watching out for them is going to slow the rise of death and injury caused by blind drivers and/or stupid manoeuvres (by both parties).

A good few hours passed by and in that time I was called to attend a drunken women who was already being attended to by another FRU and then, at the very end of my shift when, just like my colleagues, I am tired and needing to recharge for yet another 12-hour night, I got called north to a ‘chest pain, back pain’. A crew arrived as I pulled up but I had to stick around because if this was a cardiac problem then a paramedic would be required to be there. To be honest I thought the 22 year-old man would have back pain and somehow that became chest pain but he told me he had a recent history of Pericarditis and he’d been suffering chest pain over the past few days.

His ECG was abnormal, with hypertrophic ‘R’ waves and concave ST elevation. He was a fit man who worked out, so his muscle bulk and his recent diagnosis may have been the cause of these anomalies but he told me he took cocaine regularly and that changed the colour of it. We blued him in to the most appropriate hospital, just in case he was having one of those sinister MI’s that always catch paramedic people out (sometimes to the cost of their careers). I felt it better to be cautious with him than blasé; you never know, right?

I was late home, with my sore throat, my stupid cough and my generally unwell personage. Sleep was going to be limited because Harry would be up and around with his mum and they had visitors, including another child – an older one – and that meant noise. Night shifts with late finishes are no fun.

Be safe.

Friday, 16 April 2010


Day shift: Six calls; three by car; three by ambulance.

Stats: 1 ? drug o/d; 1 Near-miss electric shock; 1 NPC; 1 Abdo pain; 2 Head injuries.

Prostitution and drug addiction often go hand-in-hand and my first call was to a ‘drunken’ female who was slumped in a chair in a cafe during rush hour. Allegedly, according to the woman behind the counter (who was losing customers rapidly), a man left her there with a cup of coffee. She had told the cafe owner that she had spent the night with him and then said she was tired and flopped unconscious at the table.

She was a skinny, unkempt young lady of 23 and it was clear she was homeless and probably on something, so I got her to the floor and prepared to give her Narcan if I couldn’t get her to respond. Her respirations were slow and shallow, so I was ready to reverse that if it continued. Fortunately, as police arrived at my request, she began to speak. ‘I’m insane. I need help’, she told me after I’d asked her if she had any medical conditions.

When she was taken into the ambulance, a little bit of sense came out of her and she told us that she’d allegedly been robbed of cash given to her by the very man she’d slept with. This, unfortunately, is not a rare occurrence. She’s someone’s daughter and she’s on a very slippery slope. I’d be very concerned about her if I cared at all as a parent.

Later on a call came in for a workman who’d been electrocuted whilst digging the pavement up. A crew was on scene and the man was sitting in his van talking to them, so he hadn’t been electrocuted at all but he was very lucky indeed. As the pictures show, his machinery and clothing is burned beyond repair and when he hit the high-voltage cable, which was buried only seven or eight inches down, a flash struck his shirt, melting it instantly. He was thrown in the air, along with concrete and molten pavement – which acted like little bullets – and his hi-vis tabard was blown off his back, burning until someone put it out. He appeared completely unscathed.

This isn’t unusual because over the past few years we’ve been called to similar incidents where workmen and women have been lucky (a few not so lucky) as a result of close calls with deadly voltages because of old and shallowly buried cables.

The crew took him to hospital and he was given an ECG in the ambulance; this is always a good precaution, regardless of the amount of luck an individual has had with electricity.

Then a No Patient Contact when I was beaten by the crew (StuFru second responder at your service) for an 87 year-old man with DIB at a railway station. Meanwhile HEMS was on its way to something more serious in town.

It’s been Red, Red, Red all day so far but we all know that a Red2 for DIB with the words ‘abdo pain’ included usually means just that. So I conveyed the 22 year-old female with her friend in the car to hospital. She had been suffering acute abdominal pains of unknown aetiology for the past three weeks – it’s one of those things unfortunately and may never be properly diagnosed.

An Amber now, for a 60 year-old woman who fell and sustained a minor head injury. A towering Karate black belt man, fully adorned in karate clothing, stood over her as I tried to convince her that I wasn’t about to start running up to the fifth floor (she was outside on the ground, where she had been told to stay by Karate man) and back down again, so that she could collect bits and bobs for the trip to A&E, which she really didn’t need. Her cheek was bruised and there was a cut above her eye but all that appeared broken were her spectacles.

Unlike the next patient – a 50 year-old Spanish man who stumbled down steps in a shop and probably broke his nose. His family was on scene and the staff was doing damage control and blood clear-up when I arrived. He had no other injury that was worth worrying about and there was no loss of consciousness, nor neck pain, etc., so he and his family, who argued in Spanish throughout, went in the car to the very crowded A&E department.

Be safe.

Monday, 12 April 2010

R & R

Day shift: Five calls; four by car; 1 No trace.

Stats: 1 BPV; 2 Falls; 1 eTOH.

First Trimester BPV is common and usually not something a pregnant woman should worry about but all instances where more than ‘spotting’ is experienced should be properly investigated to rule out miscarriage, which is also common at this stage. I reassured the 31 year-old who’d called an ambulance because she’d started to bleed and stain while out running in the morning. She was with her friend and seemed calm enough but it’s always a good idea to instil more confidence to ensure that the patient knows that things will probably be okay. The nurse did the same when I got her into A&E, so she was made doubly aware of the possibility of normality in her pregnancy. After that, it was up to the specialists to confirm or deny our words. Hopefully they will be confirmed.

A 45 year-old Indian lady took a tumble onto her knee when she tripped on the raised section of a pavement ramp, so the MOPs quickly surrounded her and threw her into the recovery position for some reason. She was perfectly able to put weight on her scraped leg and her injuries were otherwise invisible. Still, she said she had shoulder pain and I took her and her colleague to A&E for a wee check.

A bit of Glaswegian translation was required for my next patient, a 46 year-old fellow Scot and alcoholic who fell asleep on the pavement. This is a dangerous thing to do if buses are passing by because it will almost certainly cause a MOP on board to call 999 in panic. A brief, travelling description and a vague location will be given and then the MOP will go about his/her/its daily business knowing that whoever was trying to rest on the public path will be dragged to hospital for no reason other than ‘it’s safer’ and spend a few hours taking up medical time just to be launched back outside again and into the arms of alcohol. ‘Thanks son, yer a diamond’, he said as I wheeled him into a cubicle. A genuine Glaswegian compliment that is.

A red1 Cardiac Arrest became a ghost when I travelled south with a motorcycle unit and found nothing on the pavement, even though the caller was adamant there was a 60 year-old man ‘not breathing’ and ‘looking unwell’ (as you would). He’d obviously felt better and walked off.

I have another soldier’s tale to tell – this one, a 23 year-old guardsman came back with his company from Afghanistan, got drunk to celebrate his R&R and fell down, cracking his head open in the Barracks where he stays. The company Medic was on hand when I arrived and the young man was conscious but had a large gash in his scalp that would need closing. He got drunk, as did the others, to forget the five who never made it back and I can’t blame him for trying to inebriate his way out of reality.

I took him and the Medic in the car and while he was waiting in the A&E corridor (in a queue of patients), another drunken man, this time not in uniform, shook his hand, tried to hug him and gave him £10 as a token of appreciation. I found this ironic and heart-warming at the same time.

I left him in a cubicle as he vomited for the second time, ruining the sheet I had just put on the bed. Never mind. He and his like are worth the trouble in my book - they have paid their dues.

Be safe.

Sunday, 11 April 2010

Age concern

Day shift: Eight calls; two by car; one treated on scene; one arrested; two left at home; two by ambulance.

Stats: 2 Vomiting people; 1 Generally unwell; 1 False alarm; 1 Hyperventilation; 1 Damaged toe; 1 Sprained knee.

An 18 year-old Portuguese girl complaining of vomiting on and off for the past few days called an ambulance to her hostel and I was sent to investigate and convey if necessary. Actually, it wasn’t necessary for her to go to hospital at all but, as a visitor to the country and with a bunch of concerned teenaged friends lolling around on the bunk beds in the room, I felt it best just to take her in. She’d have ended up there anyway I think because they would have thought there was no other option.

She’d been throwing up for three days and believed it was probably milk she’d ingested that had done it. Apparently she cannot digest the stuff well and had mistakenly drunk some. Now she was ‘collapsing’, although I soon made that less of a problem by reminding her that vomiting did not remove the ability to walk... nor did it cause eye problems, so she stopped walking around with her eyes shut.

Another vomiting female who thought an ambulance was appropriate was the 38 year-old Spanish woman who was on her way to work when she felt ill, cold and threw up once in the street. She had no past medical issues and no allergies and, when I checked, no obs problems. All she seemed to want to do was flop over onto her bed as I attempted to get BP and BM readings, making life awkward. I knew she’d do this in hospital but she wouldn’t be going because she probably had a viral infection and that could be self-treated at home. The last girl I took in is still waiting in the front area of the hospital, so it’s pointless taking person after person in for these minor ailments.

I got her agreement about staying at home – she wanted to sleep anyway – and went to do the paperwork but when I tried to get back to her for a signature and to give her a copy of her PRF, there was no answer at the door. Neither her, nor her neighbour, who had let me in, bothered to come and let me in again. Nice to be loved.

You know that point in your life when you reflect on becoming old and infirm or you see others in poor old age condition and you think (or say out loud) ‘I’m never going to get like that’ – in fact, I’ve told my wife to shoot me before it happens – well, somewhere along the line it happens anyway. I was asked to assist an Urgent Care crew to ‘sign off’ their patient, a 94 year-old man who’d fallen. He lived in a squalid little flat, surrounded by carbohydrate foods like crackers and bread and sat in a chair all day in his front room with no entertainment or diversion. He suffered dementia but was otherwise without a medical problem that needed constant care. He did, however, look extremely dehydrated and malnourished – his bony frame and weak musculature was more the consequence of his limited diet than his age and for that reason I wanted him to go to hospital. He refused, however, and even though his capacity to do so was limited, we weren’t about to drag him away from his home, no matter how bad things seemed. He simply didn’t want any help.

I’ve seen this many, many times (as have my colleagues) and it’s a real predicament for a professional carer to be in. I asked to speak to his GP but was called back by the out-of-hours service instead. In the evenings and at weekends this is what we have left in this country, visiting doctors who neither know, nor have too much time for patients they call on – there’s just too much going on. So, the man was left with paperwork (there were many PRF’s from previous visits) and a promise from the doctor’s service that someone would come and see him later on.

Around his walls were photographs of family and I was surprised to learn that this Jewish man was receiving no visits from relatives at all. I may be ignorant about the culture but I believed that Jewish families had stronger bonds than that. He’d also received a ‘good citizen’ award back in the ‘90’s from the Council, so the man had substance and yet, there he was, sitting alone with only his thoughts and one visit per day from a care service. We have a lot to answer for in this country, especially when we are currently bickering about how much we should spend on things that, in the shadow of this, really don’t matter.

A false alarm to Shaftesbury Avenue where police had just arrested a man for being drunk and disorderly. I had been called because he had been on the ground shaking and people thought he was fitting but apparently he was just mucking about. One of the cops – the one who marched him into the van – was the tallest police officer I’ve ever seen. His colleagues told me he was over 7 feet and the tallest cop in the world (apparently). I needed a step or two just to talk to his chest.

Immediately after this another call was generated for the 94 year-old man from earlier. I knew this would happen and it was made worse by the fact that the doctor visiting him had to report him as ‘collapsed behind locked doors’ and that was because the ‘care’ company who’d been asked specifically to get a key holder on scene when the doc called - didn't. However, try as she did to contact them, the call was not being answered or she was being referred all over the place. This is a disgusting situation and fairly typical of the so-called care we give the elderly.

The police had to break his door in and he was sitting pretty much where I’d left him but this time he was definitely going to hospital. It was tricky because he still refused and he even grabbed my hands, pleading and saying ‘please don’t force me to go there’. It was heart-breaking but after he’d been lifted into the chair he accepted what was happening and it was therefore easier to take care of him. I wish it didn’t fall to us to carry out these ‘enforced’ hospitalisations but with no capacity and him being a vulnerable adult and a danger to himself, there wasn’t much choice. The GP agreed, the crew on scene with me agreed and the police agreed.

Three armed cops, two Fast Response Units and one ambulance is probably over the top for a 40 year-old female who had been told by her GP that she was prone to panic attacks and who was now hyperventilating in Covent Garden. She asked the police officers to help her and they kindly put her on Oxygen and sat her in the back of their car to await us but because it was a Red call for DIB and tight chest, everything was seemingly sent. Never mind, the eight minute target was reached, so all’s well and all that.

As I did the paperwork for that call a young lady wandered up to the car and asked for help with her poorly foot. She worked in the local pub and had dropped a heavy beer keg onto her big toe, crushing the nail but not breaking the bone (well, it was unlikely and even if it was broken, very little could be done). She smiled bravely in the back of the car as I put another dressing on to replace the one she’d treated herself with. She didn’t want to go to A&E and so she got advice about pain relief and elevation...oh and wearing the correct shoes when carrying heavy beer kegs.

It all ended with a slightly sprained knee that came in as a possible broken leg, caused during a game of football. Considering that the 24 year-old Moroccan man had sustained the injury five hours previous to the call, it was unlikely from the off that it would be broken. I took him in the car. Of course.

Be safe.

Saturday, 10 April 2010

Spring has sprung

Day shift: Three calls; one treated at scene; one by car; one by ambulance.

Stats: 2 Abdo pains; 1 Drug o/d.

A bright start to the morning with a sunny day expected, for a change and I began with a rescue mission when I noticed three young girls who looked lost on The Strand. It was early in the day and I figured they must have been out all night and now they couldn’t get their bus home. As they wandered along the street I decided to ask them if they were okay because if these were my daughters I’d be concerned about what they were doing and their planes for getting home safely. None of them looked older than 13.

The only way they could get a bus home was to get to Waterloo Station, so I called it in and made sure Control knew that I was taking them there. I dropped them off and they waited for their bus in a more public place. During the trip they agreed that ‘ambulance people’ were much friendlier than the police because apparently they’d called 999 and asked for help, telling the operator that they were lost and giving their ages. Now I would have thought they’d get some assistance due to their youth and exposure to the less savoury characters on the streets at that time of day but they told me that they were called ‘time wasters’. Whether that’s true or not, I don’t know but if it is, I wonder what would have happened if one or all of them had fallen into danger.

Then off to a hostel where a homeless man lay on the ground complaining of abdominal pain. He had a large, angry-looking lump in the middle of his belly and that probably meant he had a hernia. At first he was verbally aggressive but I stayed calm and hoped he’d follow suit, which he did. I think the other street people around him had been winding him up. I asked for a crew because I wasn’t going to carry him in the car and an ambulance turned up within a minute.

The man told us he’d been a session musician in the 60’s and 70’s and, being an ex-muso myself, I was interested to hear him talk about the people he’d worked with; John Lennon and Robert plant, for example. It also interested me to see where he’d ended up as the direct result of a ‘Rock.n.Roll’ lifestyle. He’d become an alcoholic drug addict and this had brought about his down-fall. Now he lived on the streets and had been in and out of prison for the past ten years.

One of the cheapest and easiest ways to save a life is to administer Narcan after an overdose of Heroin but it’s all too often a thankless task because, like the next patient I was called to, she was a deliberate self-harmer (in terms of drug abuse) and when my colleague (a crew arrived with me) gave her the drug after we found her barely breathing on the floor of her squalid room in a hostel, she recovered and began to rant and rage about it as if her life wasn’t the issue. I thought she was pregnant when I first saw her – she definitely had a ‘belly’ that looked as if it held a human being inside but her friends insisted she wasn’t. She just had a pregnant looking belly I guess. We may well have saved two lives today but there won’t be any medals or tea for it.

It was a lovely day for sitting on stand-by in Traffy Square and I was watching the world go by when a young lady approached me and asked if I could check on her father. He was suffering acute lower abdominal pain which was radiating south to his groin. I spoke with him about it for a few minutes and told him it may be a stone he was passing. He had no medical history of significance, unless a hernia from the past was causing secondary problems but I doubted that. He didn’t want to go to hospital and I gave him advice about fluids and waiting for it to pass and he went off with his daughter.

A few minutes later, as I was discussing politics and the weather with a police officer, his daughter returned and asked if I could take him to hospital. Apparently it wasn’t getting any better and she told me he was famous for playing down serious things, so I took this into account and offered to take him in the car. His daughter travelled with us while his wife and other family friends/relatives made their own way on foot to the hospital.

Unfortunately, the pensioners of England had banded together for a protest march 5,000 strong and the roads were now shut or blocked by traffic, so it was a slow trundle towards A&E initially but I took a detour and we made good time. I don’t like the thought of anyone in pain being delayed help and after being told how stoical he was by nature I wasn’t going to underestimate his discomfort. As for the marching pensioners (or maybe it was their siblings), none of us held a grudge about the delay because whatever they are fighting for, they probably deserve.

During the trip we chatted about Northern Ireland, particularly the town where the gentleman came from and had lived all his life. I’ve been there (once) and we discussed the circumstances that took me there. We also covered other topics, including midwives, just for the hell of it. Oh, and his daughter sounds Australian – she has that Antipodean twang to her voice but she strongly denies having anything to do with the continent, so we agreed that she probably watched too much Ozzie soap stuff on TV. Honestly, though, she should admit to being a throwback to an earlier age – and like some of my lot in Scotland, we all know why they went there, eh?

I enjoyed this call because these were people I could talk to and relate to without minding my P’s and Q’s too much ‘cos - and those who know me understand this - I’m not that good at it.

Be safe.

Sunday, 4 April 2010

Easter Eggression

Night shift: Six calls; two by car; four by ambulance.

Stats: 1 Drug o/d; 1 Stabbing; 1 EP fit; 3 Assaults.

Happy Easter! Well, for normal people that is. Not so for the 20-odd year-old male who was reportedly lying in the street shouting out and misbehaving. The police couldn’t find him when they arrived but he’d moved on to an underground station where we found him on the floor, thrashing around and being an idiot while families walked around going to and from wherever. He was surrounded by British Transport Police who were bemused to say the least. But he was quite ferocious when I tried to get information from him and he grabbed my arm and pulled it until I felt the shoulder click. He also had a nasty thick bracelet on and this was sharp enough to slice one of the officers on the hand when he tried to handle him.

With the crew’s help we managed to get him to the ambulance and into hospital where he became less belligerent. He’d been clubbing all weekend and was out of it on GHB. In my world, he’d go to hospital, ‘sober up’ and then receive a heavy fine for his troubles. If he didn’t pay the fine, or repeated the offence, he’d go to jail for a while. In this world, he’ll do it again and again at our expense.

A stabbing in Regent Street sent us to a sea of blue lights for what turned out to be a hand injury. The guy had been stabbed and he was lucky his wound was relatively minor. It would probably need stitches and a crew was already on scene and dealing with him, so we left and got our next call immediately.

In one of the less luxurious tourist hostels (still calling itself ‘Hotel’) a 17 year-old epileptic may have had a fit and a crew was on scene but I was asked to assist in case she had another and drugs were required. It’s likely she had an ‘absence’ because she has no memory of a few minutes of time and was only aware of voices in the room as she lay on her bed, tired after an exhausting day out.

She remained stable and alert and I left the crew to it but not before having a word with the Manager of the hostel about the fact that the only elevator available was being used to transport rubbish around floors when the young girl, strapped to an ambulance chair, waited on the fourth floor with the crew and her teacher. If she’d had a seizure her treatment would have had to be given there and then. Most Hotels give the ambulance service some priority when they make their 999 calls.

An hour or so past before our next call and we were off to the West End for a Big Issue seller who was allegedly assaulted by some young men as they walked by. The poor guy was left on the pavement with his newspapers strewn around him. He was tearful and understandably angry about what had happened to him, and the police, who were on scene when we arrived, were very kind and sympathetic. They had caught the assailants nearby and at least two men were arrested.

The man didn’t want to go to hospital (against advice) and he was adamant about this, so we offered to take him home to his Hostel instead but as we arrived on the street where he lived another call came through for an assault on that street. The police flagged us down and the poor Big Issue seller got out and walked the rest of the way home. We wanted to take him to his door but he knew we had another patient to deal with now and insisted on leaving us to it.

This assault victim was inside a Salsa club - he had been chased down by another man after dancing with a girl the alleged assailant was with. He objected and started a fight (allegedly) which ended with our patient lying on the floor, receiving a bottle to his head, which shattered on impact, leaving him with a cut to his forehead and hand, which I assume he held out to defend himself.

There were no ambulances nearby so, given that the wounds were fairly minor but would need closing, and the patient was stable, we took him in the car to hospital with a police officer on board. This meant he got to where he could receive treatment before his condition deteriorated, if it was going to at all. The man was so obsessed about his appearance that he tore off the first dressing to look at his scalp wound and he fiddled incessantly with the dressing wrapped around his hand. He had to be told time and time again to stop touching his wounds with his filthy paws. Please note the word ‘paws’ was not actually used in the making of that conversation.

The next assault took place on Oxford Street. A 20 year-old Chinese man got himself into an argument which turned into a fist fight. He received a punch to the cheek, which probably broke it and that should have been that but two other men decided to get involved and they punched him to the ground. He hit the pavement so hard that the back of his head split and I could feel a large bump forming there. It left him unconscious for a few minutes and concussed when he came round. Police were already on scene and the hopeless task of finding the alleged assailants began. According to witnesses, it sounded like the men had taken a bus after the attack. I’ve been on plenty of calls where thugs have beaten someone up and then, with the bus driver knowing what had happened (or even witnessing it), they have still been able to hop on a bus and go home with no questions asked and no report being given after the fact. The fear created by these maniacs has driven people to silence, even when they can make a difference.

A crew arrived as the obs were completed and we left him in the back of the ambulance with a rising BP, which could be significant, and rambling repeatedly about what he remembered of the fight – although he couldn’t remember the number of his house.

Be safe.

Saturday, 3 April 2010

Special K and alcohol

Night shift: Six calls; five by car; one left at home.

Stats: 2 eTOH; 1 Faint ? EP fit; 1? Food poisoning; 1 Allergic reaction; 1 Abdo pain.

The first call was for a drunken 49 year-old female but she had a story and her vulnerability made the call all the more poignant. She was found slumped on the pavement – quite drunk – by a MOP who called an ambulance after it was allegedly said that the woman’s husband had abandoned her there after a fight. A motorcycle colleague was with her when we arrived to convey her in the car and during the trip she cried and made several allegations of violence against her by her husband. True or not, the fact that she had said it made it imperative that I take note of it and make sure it went to the right place. This poor woman blamed herself for the physical abuse she was apparently receiving regularly.

A 25 year-old man was sitting with his friends when he had an ‘aura’ that he was about to pass out. This has happened to him before and it is triggered by something he sees or experiences. Then he fell and smashed his face on the floor, cutting his eye on glass that followed him from the table as he fell. His mates thought he had been joking.

He then had a short seizure, which may have been nothing more than the consequence of a brief lack of oxygen to his brain or it could be that he is epileptic and doesn’t know it. Whatever the reason for his collapse, he was taken in the car to hospital. His eye would need minor treatment and an investigation into why he has these ‘faints’ should be carried out. He was completely lucid when we arrived and his two friends joined him for the trip.

At a theatre, in an empty post-show auditorium, a 40 year-old woman suddenly felt ill and vomited violently onto the carpeted floor. Theatre staff and her husband were on scene and she was shaking like the proverbial leaf when we arrived. She had no medical condition significant enough to have provoked such an acute bout of sickness, so after a few questions and a look at her obs, I could only assume that something she’d eaten had done this to her. She had abdominal pain and a bloated feeling and this often accompanies food poisoning. Maybe a lack of basic hygiene in the restaurant they’d both had dinner at four hours earlier could account for this.

There were no ambulances immediately available and she was stable enough, with a clinical waste bag for vomit management, to take to hospital in the car.

Metoclopramide would have been useful and I could certainly have given her some to reduce the vomiting but it would cost her ten minutes of feeling rubbish in a public place and I had a five minute journey to hospital in mind. So she got me, Sarah and her husband by her side to help her into a less fragile state of mind.

Later on, as the locals tanked themselves up on cheap booze (regardless of the recent budget hikes), we were sent to check out a 32 year-old female with a history of anaphylaxis who was having an allergic reaction. Luckily for her the problem she was experiencing was very mild – facial swelling that was insignificant and went no further than her gums and cheeks. She had no rash or breathing problems but she was worried because she’d been given no education about her condition and has had to endure these low-level reactions on a regular basis without knowing the cause or the remedy. She’d taken an antihistamine and her condition was stable.

She sat in the front room of her perfectly decorated Muslim household with her father, who insisted we sit down and in such households I feel obliged to do as I’m asked in case I offend the host. Also, without bias, I wasn’t keen on trundling a decent, law-abiding, non-drinking woman up to a crowded A&E packed with the debris of a Saturday night, just so she could sit for four hours waiting to be told another Piriton was all she needed.

She listened to my candid advice and I filled her in on how Histamine affects her and what was going on in her body – this seemed to calm her and help her decide to stay at home, with advice to call us right back if she felt worse.

Continuing with the great ‘my drink was spiked’ spectacular, we were sent to a club where we found a 19 year-old German girl sitting with her two friends on the steps inside. She was only responsive to painful stimulus and, when bothered, would answer questions (in German and translated via her mates). One of them stated that she’d accepted a drink from a stranger (this is not wise) and that it may have been drugged. Okay, it’s not impossible but it’s not likely either – as I said in my last post, using drugs to entice a woman to your place for sex is only going to be the choice of a seedy, sad few men with a plan. It won’t work on a 6-foot German teenager with two heavy-set friends in tow. So there’s no point. Also, when asked how many drinks she’d had, the answer, as is stock and predictable, was ‘only two glasses of wine’.

‘Large glasses?’ I asked.

‘Oh no, just small ones’.

She was either out clubbing on a budget and hoping to have a free drink or ten from passing strangers or she was so drunk she’d actually forgotten the last five or six that followed the first two. Alcoholic amnesia I call it.

However, before you criticise my criticism, she may well have been offered and accepted something nasty and for that reason I gave her the benefit of the doubt and added ‘possible drugs’ to my report.

There were no ambulances and the Booze Bus was unloading a tribe of drunks at the local hospital, so we got her to her feet and walked her to the car. Then she and her two friends travelled with us to hospital where she joined the living dead of Saturday night (the Booze Bus remnants) in the waiting area.

The abdo pain call started out as a chest pain call and so a crew was being dragged for miles to get to it and I was on the doorstep so went to check it out. She was a Ketamine user who said she had Cystitis and was prone to panic attacks. I cancelled the ambulance and we took her in the car to hospital where she promptly changed her story to ‘found collapsed’. Sometimes patients will do this and you can look pretty foolish as a result.

Be safe.

Friday, 2 April 2010

The lollipop cure

Night shift: Six calls; six by ambulance.

Stats: 1 Faint; 1 Dislocated knee; 3 eTOH; 1? Fit.

The start of those magnificent night shifts I love so much but the compensation is that I have Sarah as my observer. Sarah works in Control and is ambitious about going frontline in the near future, so she is tagging along for experience and crap jokes. It’s always nice to have good-natured company on these shifts.

A 73 year-old lady collapsed and fainted in a theatre and we walked in to find her on the floor, legs raised and a small crowd of concerned people around her. She had family with her but she also had the efficient and very kind theatre staff on hand.

She was recovering from a faint brought on by abdominal pain and she told me she’d had this event before but did nothing about it. She was very pale and hyperventilating, so her recovery wasn’t swift and this concerned me more than the faint. I suggested, regardless of the lack of any distinct medical history, that she should go to the ambulance for an ECG and when the crew arrived, that’s what she did.

Her ECG was not quite right; she seemed to be ‘dropping’ P waves on a regular basis, suggesting an AV block – this could mean something significant was developing and her two faints made the necessity for her to go to hospital much more relevant.

Then a 24 year-old woman twisted her knee so badly that she dislocated the patella laterally. This is an easy fix but caution is required if the knee isn’t to be damaged, so careful gentle examination is needed. Oh, and lots of entonox, which she seemed to thrive on. Her two bemused friends stood by as she occasionally swore and more than occasionally shouted ‘don’t bang it back in!’ Obviously, with or without her tacit consent this wasn’t going to happen – the patella would just slip back into place itself if she would just move her leg the right way... but she wasn’t keen and so I acknowledged her pain and her absolute refusal to have anything drastic done to help. There was, however, the problem of getting her out of a tube station corridor and all the way up stairs to an ambulance and that would need planning.

My initial idea was to have her leg splinted – this alone would probably repair the knee instantly but the crew arrived and the leg was straightened with the effect that was desired by all – an instant reduction of that naughty knee-cap. She still hogged the entonox though and it ran out before she reached the top of the stairs, tied into a chair.

She went to hospital because the knee would require further examination. This joint is a particular troublesome one to effectively repair if it has been damaged – ligaments and other structures within can give life-long problems once they have been insulted by an injury.

A 35 year-old Lithuanian man, known to me from a saga a few months ago in which the police had to accompany me whilst he sat in my car attempting to smoke a cigarette, called for an ambulance outside a club and said he was ‘unwell’. We arrived to be told he’d walked off after waiting impatiently for a rapid response. He called again for an update on how long we were going to be, and then secreted himself around a corner until he saw the lights of the car flashing. Then he walked towards us and promptly collapsed and acted out a seizure for the benefit of the worried public. He’s done this before and it’s his M.O. – all he would say to me initially was ‘epilepsy, epilepsy’ but he soon became fully aware when I told him I knew who he was. Still, he demanded an ambulance and that’s what he got. The crew knew him too – he’d just come out of hospital (well, he was thrown out by security) and he will, no doubt, be leaving that place again soon after arriving. It could go on all night.

Multiple calls came in for the next patient – a 25 year-old female who was seen fitting on the pavement before a man picked her up and attempted to drag her away. This caused panic among the MOPs and more than a few of them made frantic 999 calls with conflicting details. This brought the police and two ambulances (and us) onto the scene. It certainly was confusing as the woman hugged the man, staggered and behaved very strangely. Not epileptic post-ictal strange but drug-induced strange.

The man with her didn’t seem to know much about her and the police were very wary of what might be going on between them. Certainly, they knew each other but exactly what their relationship was became cloudy and disjointed as each was asked about the other.

One of the crews took over and she remained agitated and whispery in verbal communication. I left them to it and the police followed the ambulance to hospital.

It would seem that the semi-torrential rain, which began to fall at 2.30am, is not a deterrent to the hard-core drinking public who imbibe too much and then blame the Gods or whatever else they can think of for their new status on the pavement. This call was for a ‘faint’ but he was slumped in the doorway of a McDonald’s restaurant, vomiting on the doorstep (I’m not amused because I go for breakfast there sometimes) and stating merely that he was ‘unwell’.

The 25 year-old told us he had a history of HepA, so drinking was probably not a good idea – thus his current state and by rebound, I would venture, an evening of alcohol culminating in a trip to A&E on the ‘Booze Bus’, courtesy of the NHS.

Another customer who needed the help of the emergency services for alcohol-induced ‘illness’ was a 20 year-old female whose friend claimed she had been ‘spiked’ by someone who bought her a drink. There’s little mileage in this excuse because if someone wanted to drug a female, his plan is probably to use that to his advantage – it is therefore unlikely that he’d top-up a drink with drugs just to watch her collapse outside and become wildly emotional about what has happened. Especially if she’s had enough to drink so that this effect is almost certainly going to be initiated without the need for drug enhancement.

She was out of harm’s way on the pavement – club staff and friend on hand with the addition of a perfect stranger who sidled up to us, looked at her sadly, tutted and then proceeded to offer her a lollipop so she can ‘get sugar’ for her drunkenness. Someone's been listening to Granny's remedies and taking them far too seriously.

Be safe.