Wednesday, 26 May 2010

Professional junkie

Night shift: Seven calls; one assisted-only; five by car; one by ambulance.

Stats: 1 panic attack;1 head injury;2 eTOH;.1 dizzy person; 1 eTOH with head injury; 1 dislocation.

A 20 year-old student had been hyperventilating for an hour or so when I arrived – not that I was late; her friends wanted to control the problem themselves and she didn’t want to go to hospital. The young lady has a fear of crowded places, so coming into London and getting involved with the public transport system was probably not a good idea.

As she puffed frantically, with her friends around her and an oxygen mask going nowhere on her face, it became clear that she wasn’t going to calm down for me – or anyone else, so I took her to the car and prepared the paperwork for the inevitable trip to A&E. She collapsed to the ground from the back seat and so I knew the time had come to stop messing about and take her with one of her friends, leaving the others to go home to Kent on their own.

I started the journey and realised I didn’t have my paperwork with me. The reason for that became clear a few seconds into the trip when my folder slid down from the roof, where I’d left it, onto my windscreen. Luckily, it slid nonchalantly, so I think I got away with it. Unfortunately, however, my cover was blown when one of the patient’s friends ran up to me and handed in the PRF I’d just completed. It had blown into the street when I took off. I don’t think any of that helped my patient’s breathing.

Then I was sent to a possible assault with a head injury, promptly cancelled for a higher priority (allergic reaction) and then cancelled again to be re-instated on my assault call. The 30 year-old man had allegedly been chased down by door staff at a pub – he fell down stairs and bashed the back of his head. Police were on scene and the patient was nursing a painful noggin when I got there. He was complaining bitterly about the ‘murderous’ doorman but I had to take his head injury seriously because he said his skull was tender to touch where he already had scars from a RTC-related head injury he’d sustained years before. That time he needed emergency hospital treatment, so I opted to take him in the car with two police officers flanking him. He’d been arrested and was cuffed.

On the way, a call came in for a RTC in which a pedestrian had been struck by a car right on the route I was going to travel. Control asked me to stop and render aid and the two cops had to sit in the back of the car while I did so (the man who’d been hit was drunk and had been clipped by a taxi. He was conscious and breathing). When a motorcycle paramedic arrived to take over, I continued my journey but now my patient was getting drowsy, so I sped up and got there quickly.

He was taken into a Resus bed for observation, police at his side. In the midst of it, a woman with lots of tattoos threw herself to the floor of her own cubicle, tearing the curtains from the hooks, and proceeded to have the worst ever acted fit in history. She was so bad at it, the police around her paid no attention and the nurses stood and told her off as she wriggled like a worm. It was going to be a crazy night.

Two words that come up very often on a Wednesday night are ‘drunk’ and ‘student’. Even the country’s most intelligent minds haven’t yet worked out the limits they have for alcohol... or they simply don’t care.

A 24 year-old Chinese girl collapsed on an underground train and I found her lying on the platform with staff members, an off-duty police officer and an off-duty nurse tending to her. A friend was sitting on the bench but she was very drunk and I preferred to talk to the nurse and cop initially.

The girl had downed a bottle of wine (her and her mate had drunk two between them) and now she was vomiting on the platform as passengers got out and walked around her, staring and gawping in mock interest. I got very little response from voice but she moved when a painful stimulus was given, so she wasn’t too far gone.

A crew arrived within ten minutes and we bundled her up to the ambulance for a trip to hospital that had her friend crying and wailing and would no doubt cause the young unconscious lady some degree of shame when she woke up.

A 27 year-old man suddenly felt dizzy and light-headed whilst going home on the underground, so he got out of the train and asked staff to call him an ambulance. I was sent and I took him in the car to hospital. He had no medical history but this had happened to him before and his GP had diagnosed stress and that may well be the case but a constant feeling of light-headedness and faint could also be significant, so an ECG would be a good idea.

The more intelligent members of society also seem to be more likely to become obnoxious when drunk. I see it as a sign of repression; they may always be of that nature but they manage to hide it well enough until alcohol disinhibits them.

A 35 year-old woman fell down and banged her head on the pavement, so her friend called an ambulance and I arrived to a drunken patient who was a little annoyed that I was trying to help her. She had a lump on her head and her bemused friend had to keep her restrained when she began to get a little rattled about her predicament.

I took them in the car to a crowded and noisy A&E department, where the fire alarm rang out incessantly, a very small baby vomited through its mouth and nose and a cubicle containing a supine, star-legged man having his hands held by two large and unshaven transsexuals made the whole thing surreal. They must have thought they’d been taken to a bad dream.

She mouthed off at the nurse for no reason (something about ‘do you know who I am’) and had to be told to show some respect. I left her in the nightmare called A&E.

I went onto the FRED system after midnight and calls bombarded me as expected. They were cancelled one by one but I am still expected to start running on them – I’d be starting and stopping at a ridiculous rate if I did, so I waited for one call to settle and went on it.

I was soon in a dark little alleyway, on my own with a man who appeared to be folded over on his front in a doorway. He was outside a pub and he looked to be either asleep or dead. Luckily, when I shook him hard enough, I found that he was alive and for the first time in a while I was being very cautious about him in case he turned on me because I had nowhere to escape to in this little street.

Then a young woman appeared from inside the pub – she had called the ambulance because she couldn’t wake him and didn’t want to touch him. He could have been a drug addict who’d overdosed and I can understand her reluctance. The guy soon sparked up, however. He told me he lived locally and was just drunk but that he could walk home. Fair enough, I thought. He got a free bottle of water from the friendly pub girl and staggered off into the night.

Soon after that call I was asked to assist an off-duty paramedic who’d dislocated his shoulder ‘whilst dancing’ the info stated. I found him on a bar stool in a pub that was closing for the night and he told me he’d dislocated his shoulder posteriorly. He also asked for an analgesic we no longer carry and an anti-emetic we never used and this had me thinking.

His shoulder was out of place and I gave him entonox and a small amount of morphine (and metoclopramide; the anti-emetic we do carry) but he vomited violently all over the floor, my bags and my uniform. My boots and trousers were peppered with sick splashes that I knew wouldn’t come off easily. It was almost as if this guy knew what was going to happen if he received morphine – he’d even specified the cannula size and site for the IV injection – it was all a bit strange, so I stopped all analgesia and took him in the car (once he’d stopped throwing up) to A&E.

Once inside, the nurse recognised him. He’d told me he frequently dislocated his shoulder and the reason he’d given for tonight’s mishap was that someone had bumped into him as he left the toilet. Someone, somewhere had said he was dancing, didn’t they? The nurse in the hospital (which he’d asked to go to) said he’d been in four times this week.

I asked him about carrying patients and bags, etc at work but he didn’t give an answer. Then a crew took me aside and explained that they knew this young man. He wasn’t a paramedic at all and he frequently worked this number to get morphine. After all these years I felt like a prize chump.

Be safe.

Friday, 21 May 2010


Day shift: Three calls; three by ambulance (or possibly one left on scene).

Stats: 1 ? heart problems; 1 stressed alcoholic; 1 hypoglycaemic.

A woman in a hostel thought she was having a heart attack because her heart was beating fast. In fact it was beating regularly at 80bpm – so quite normal. However, we mustn’t be complacent and she did say she had cardiac issues – possibly tachycardia – so I left her with the crew to be taken to hospital. If I am honest about it, I think she was a panicky person; she had a short list of medicines that she took every day and not one of them was for cardiac arrhythmia. She also said something that made me think another factor was at play. ‘My daughter’s a doctor’, she said.

I felt very sorry for my next patient – the 48 year-old woman was in bed and her husband was on scene as she panicked and stressed her way through a conversation with me in which she explained she was addicted to alcohol but was desperately trying to stop drinking. Her fear was that she’d have a fit and so she kept drinking (less than usual) to avoid that possibility. Her fear of the consequences of withdrawal was actually keeping her in the unhealthy condition she was in. She had lost 10kg in a few weeks and looked very unhealthy and dehydrated.

She was stressing about her husband, who’d just been to hospital for an operation, and this had brought on chest pain. When the crew arrived (my son and his colleague), we got her into the ambulance and I gave her fluids and left my bag on board in preparation for any sudden crisis as I followed the crew to hospital. Unfortunately, the ambulance wouldn’t start and another vehicle had to be requested. The street was narrowed and lorries couldn’t get past; one driver had already had a go at me because the ambulance had been ‘in the way’ for 20 minutes. I spent ten minutes calming him down and working out another route out of the street (in the end he reversed all the way back up the road and I led the way to make it safe).

By the time all that was done, the other ambulance had arrived and began transferring the patient. I got into my car, did my paperwork and drove back for a meeting I had to go to. Meanwhile, the ‘broken down’ ambulance started up again and I soon got a call to let me know that I’d left my bag on the vehicle!

The next patient was thrashing around on the pavement with a small dog at the end of a leash. He had a MOP and two police officers with him... and a bottle of Lucozade, purchased by one of the cops. People had apparently passed him by thinking he was just drunk, although a little bit of thought would help you realise how rare it is to see someone stinking drunk and walking their poodle.

His BM was 1.7 and he was a known type I diabetic. He got Glucagon because he wouldn’t drink the fizzy stuff, and within a few minutes he was more amenable to a free drink. This brought his sugar level up to 2.2 and the crew, who arrived just after the injection was given, took him into the ambulance for more Lucozade and further checks. He will likely have been sent home after that.

Be safe.

Thursday, 20 May 2010

Welcome to London

Day shift: Seven calls; four by ambulance; one by car; one left in care; one left with police.

Stats: 1 unknown problem; 1 SOB; 1 fall; 1 ? rib fracture; 1 poisoning; 1 fall with head and hand injury; 1 sleeping person.

Mystery calls can turn into something or nothing, depending on everything.

Before breakfast, a 40 year-old man was found collapse half-in and half-out of the road and police officers were on scene by the time I got there to check on him. He was conscious but making no sense – he kept repeating the same thing; some ‘boys’ had hurt him. He appeared to have no physical injury and he denied drugs or alcohol. His vital signs were normal but he couldn’t keep his eyes open and drifted in and out of sleep.

We managed to get him into the ambulance when it arrived but he remained vague about what had actually happened to him - very strange, although conjecture lends itself to several possibilities given the area he was in, the time of day he was found and the statement he kept repeating.

The man on the park bench complaining of shortness of breath (SOB) and who asked a member of the public to call an ambulance for him was known to me. I picked him up at the weekend and took him to hospital in the car. He recognised me and I asked him what happened at hospital because they wouldn’t have let him wander out and sleep rough if he still had this problem. He admitted that he didn’t let them complete their tests; he didn’t like being ‘prodded’ and ‘treated like a pin-cushion’.

An ambulance arrived for him this time and I handed him over to the crew. He is a non-compliant patient who, if he has a serious health problem, will never get it treated if he continues to run away from hospital after all the trouble we have gone just to get him in there. I explained this to him and he said he understood. Let’s see if he shows up again in a few days.

After a cancelled call for a man who stood on a rusty nail and then thought better of a full-blown 999 emergency response, deciding instead to do the grown-up thing and go to A&E himself, I was sent to assist a 52 year-old disabled man who stumbled down a Post Office step as he exited. The man had very limited use of his legs (they were stumps basically) and got around on a mobility scooter. When he had to move without it he had to go on all fours and 'walk' that way. He had no injuries and a police officer was with him when I arrived. All he needed was help with a major underpants and trousers malfunction – the clothing kept falling down and he was very frustrated about it – he shouted at them as if by magic they’d sort themselves out. Instead, I found myself dressing the man in the street. I suggested braces and he told us he already owned some but didn’t like them. I think, considering he was butt naked in front of women and children in broad daylight, he may want to reconsider his waistband suspension aversion.

His carer came to collect him and I handed the paperwork over to her.

A very pale 38 year-old man sat on the first aid couch with the office first aider, waiting for the ambulance to arrive. He’d fallen from his mountain bike at the weekend and thought nothing of the bashed rib he received. Then, when he came into work this morning he coughed and this produced acute, severe pain, making him feel faint. He was quite off-colour when I saw him and he coughed a few times and certainly seemed to be experiencing pain in one area of his ribcage each time. I listened to it but only heard air going in as normal. There was no ‘bone against bone’ crepitus either but a fractured rib couldn’t be ruled out, so he went to hospital by ambulance.

The next call was for a Polish alcoholic man who’d been taken off a train at a station because he collapsed after drinking stolen spirit gel. He then collapsed again when they tried to make him walk away. So British Transport Police took him to their little office and we were called.

He had two pump-bottles of gel - a hand sanitizer that contains a concentration of alcohol. Some alcoholics mix it with juice to get rid of the taste of the chemical that is supposed to inhibit the drinking of it – they can’t get the real thing or the real thing just isn’t strong enough, so they poison themselves with this stuff. One of my known patients from a few years ago died as a result of continually drinking this. I told the man he could die but he just shrugged and then made a hand-washing gesture. He had filthy hands, so I was reluctant to believe that he carried so much of the stuff because he had a hygiene habit.

A crew turned up and took him to hospital and I went on ahead for two reasons – firstly, the man had over a dozen aliases, according to the police, so I went to see which one he had registered with when he last went to hospital (I found one immediately) and secondly, to give the nurse a heads-up on his habit because they still have lots of these gel bottles around and he was absolutely positively going to steal as many as he could before being discharged... or walking out, which was more likely.

There once were two girls from Vienna... well, anyway, one of them fell down a few concrete steps while touring London (as you do) and got herself a minor head injury, comprising a small cut to the forehead and a painful, swollen, possibly sprained little finger. Two police officers were with her and her friend when I arrived and, after a few bad jokes and an examination, I conveyed them to hospital.

Both girls had very un-Austrian names and both spoke good English. I happen to like Austria; it’s where I go to ski with the family whenever we can (not Harry yet of course). I’ve been to the country five or six times and visited Vienna once. It’s all very pretty in places, especially in the mountains. In fact, if it wasn’t for The Sound of Music, I wouldn’t have believed it was really like that, although I've yet to hear anyone yodelling out there.

I left the two of them in the waiting area. I hope they continued their mini-tour of London without any more mishaps.

A Red2 – ‘unconscious’ turned out to be a street-dweller who was fast asleep on the pavement outside a McDonald’s. She was curled into a ball and looked a bit dead to be honest, so people got a bit panicky and the Manager of the place called an ambulance. To her credit, she did prod the person a few times but there was no response, so I had a go, using my timed-honed LAS person-wakening skills. It took me three seconds to get an arm swung at my face and an abusive response from the person – who turned out to be a woman.

Once I’d got her to see sense, she got up but headed straight into McDonald’s, followed by the Manager and a PCSO she’d asked to help. She didn’t want the vagrant inside her restaurant. The rough sleeping woman was going to use the toilets but, as in any establishment like this, it is up to the Manager to decide who does and does not use the facilities and they preferred not to have her custom.

The woman was ejected under escort and proceeded to shout abuse at a complete stranger who happened to be standing outside. She’d asked her something and the unknown woman had said no. This was followed by ‘You f***ing miserable old cow’. Nice.

Be safe.

Wednesday, 19 May 2010

People keep falling down

Day shift: Six calls; four by ambulance; one by car; one left on scene.

Stats: 1 cardiac problem; 1 fall; 1 head injury; 1 hypoglycaemic; 1 infected arm; 1 tired person.

A strange start with a call that went Red1 for reasons I will never understand – for a 35 year-old cyclist who basically ‘tumbled’ off his bike, according to witnesses. The MOPs said he lost consciousness briefly but nothing hit him and he wasn’t going very fast when he fell from his bike. He lay on the pavement, confused and a bit restless, so I checked his BM and found it was normal. He denied having any medical problems, or having taken drugs or alcohol recently, so he was a bit of a mystery. His behaviour was erratic and childish but he was perfectly able to obey commands and got onto the trolley bed without much help when the crew arrived.

Meanwhile, an annoying whistle seller was standing nearby making repetitive bird sounds with one of his whistles. After a few seconds it was driving us all nuts – God know how he sells those things without getting one wrapped around his neck.

The patient was ‘blued’ in by the crew and I knew that the crew had found something that warranted it; his behaviour was abnormal and that usually indicates a brain insult of some kind. Later on, the crew told me that his ECG was anomalous – he had long QT syndrome in fact. This explains his loss of consciousness, which probably happened as he cycled along the road.

Next up, a 31 year-old man who works as a security officer in a large bank sustained a minor head injury when a heavy vault door lock hit his head as it shut. He had bent down to pick something up from the floor as the door was closing. He was lucky not to have been crushed by it.

I took him in the car because, head injuries with symptoms, such as the nausea and general weakness he still felt almost an hour after the accident, should be checked out.

Falls and bumps to the head, with no symptoms and a potentially emotionally fragile child should be left alone, however. So, the 1 year-old who fell down three wooden steps at his early years centre and had no mark, bruise, bump or other damage to his head, was left in his mum’s arms after she rushed to get there on a phone call. The worried young lady who was in charge of the child seemed weighted by guilt but kids fall – it happens... and they often bump their heads – very few of them require hospital treatment. They were told to keep an eye on him after I’d done a thorough check of his neurological state. Then I gave them the obligatory piece of paper and went on to the next call.

A crew arrived a few minutes after me, as I was giving a 70 year-old man who’d walked into a doctor’s surgery an injection of Glucagon to raise his blood glucose level, which had just been tested and was only 2.8. The man was a known diabetic and sat in a chair, looking very pale and sweaty. He didn’t respond much and wasn’t completely alert. The doc had given him milk (The American Diabetes Association (ADA) states that milk is better than juice or glucose because it has lactose, fat and protein that will help keep your blood sugar steady over time) but he wasn’t drinking it well, so a shot of Glucagon, taking no more than 30 seconds to give, would help... and it did. By the time the crew had checked him again, his BM was 3.1 and hopefully climbing. He also had a slow pulse and a wide-complex ECG, so something else was amiss and he was taken to hospital.

A large blue bag was left against the wall of Debenhams in Oxford Street and I thought I’d check it out. They tell us to be vigilant but it means we risk looking like idiots, so I asked for a cop to help me look inside the bag, just in case... I didn’t want the bomb squad sent.

I waited for ten minutes and managed to unzip the bag enough to see that a duvet was inside but I didn’t know what else, so I didn’t venture. Then a single female PCSO came to investigate. I thought they’d send the Met.

When we opened the bag, all that came out was a duvet but a point was proven. First of all, nobody seems to care if a large un-owned bag is left sitting in a prominent place and if you report it, you are likely to get one solitary PCSO.

The duvet probably belonged to a local street-person. Why he or she would leave it around like that is anybody’s guess. It’s like leaving your bedroom somewhere for the day at the risk of losing it (or having it blown up).

Off to a park for a 49 year-old man who was intelligent enough to know better than give me verbal abuse when I asked straight-forward questions. I’m a bit fed up of it to be honest. People actually think we are paid to take aggressive language and behaviour. I told him to stop swearing at me and to calm down – he seemed to get the point and did so.

He had a badly infected wound that had been stitched in hospital a few days earlier. The injury was the result of him sticking his arm into a unopened window. It was an angry, red, hot thing now and he needed antibiotics for it but I wasn’t going to take him in the car – he’d already proved how capable of turning on me he was.

While he was being checked out in the ambulance, a man with a dog on a leash toured the perimeter of the parked vehicle to have a nosey. It was ridiculous to watch because he was spinning around the ambulance, stretching his neck to see if there was anything interesting going on inside, while driving his mobility scooter.

Exhaustion can shut you down completely. Your body will go to sleep, whether you like it or not, no matter where you are or what you’re doing. If it wasn’t for this reflex, you’d die of tiredness. If you don’t die, you may run yourself so far into the ground that ill health, sometimes chronic ill health, creeps in.

It took me and the crew no more than a few minutes to figure out that the large 19 year-old man on the floor of his place of employment was just over-tired. He had a headache and claimed to be dizzy too but he couldn’t keep his eye open and he soooo needed to sleep. He’d been found ‘collapsed’ on the shop floor at work. It wasn’t until I asked his Manager to leave the office so that I could have a quiet word that he confessed to having College work to get through, as well as this job. He had exams coming up and that stress can certainly cause sleep-deprivation. But he needed sleep, no matter how much he tried to work through it, so off he went to hospital.

Be safe.

Monday, 17 May 2010

Bizarre ER update

You may remember that I told you the Bizzare ER programme (BBC3) wanted to film a few short stories, including some of the strangest calls I've been on - well the programme aired last week and I was told that they'd run short of time, so my input has now been clipped to a few shots in the lead up to their section 'Confessions', near the end of episodes. BBC i-Player has the first two episodes in and the next is due tomorrow I believe. It may be worth listening to some of the other medics who are telling their stories instead but beware, the programme is very, very graphic.


Sunday, 16 May 2010

Foreign language

Day shift: Eight calls; six by ambulance; one by car; one no trace.

Stats: 1 short of breath; 2 head injuries; 1 TIA; 1 vomiting; 1 cardiac arrhythmia; 1 invisible o/d; 1 probable o/d.

Before I’d managed to grab some breakfast I got a call for a homeless man who was suffering shortness of breath. He had a bad cough and this was probably the foundation of his troubles but I took him to hospital because many of these individuals have health problems that simply get ignored or overlooked.

Lying on the pavement in broad daylight, near a small dark pool of blood, was an alcoholic Polish man who’d either fallen or been hit by someone. It took me several attempts to wake him up but he was passive enough when he stirred - I was on my own with him for a few minutes until a crew arrived to help me.

A broken bottle lay in the car park area of a nearby estate and dots of blood led from it to where I found him but he denied being assaulted when the police arrived to ask him what had happened. He was a known alcoholic and epileptic, so I guess he may have just fitted somewhere and the broken bottle was coincidental. The crew took him off to hospital, whatever the cause of his head injury – he’d need to have it closed.

Almost as if a mirror of the day before had been brought up for me, I was off to a man ‘asking for a doctor’ but not giving any reason. He’d walked into a public place and seemed fine for an hour but when someone started to speak to him he was coming out with nonsense. When I arrived he was replying with whole sentences that sounded almost mathematical. He could clearly understand me but his brain was picking up alternative words for his mouth and his language was impossible to translate. It was clear to me that he’d had a neurological – possibly a TIA. His FAST, apart from speech, was negative but I had no history because he couldn’t tell me anything.

When the crew arrived I asked one of them to use the patient’s mobile to contact someone and get details of who he was and what might be wrong with him but during that process the patient began to make sense. Suddenly he was replying in plain English. This is what happens with TIA’s and it's what took place yesterday at the train station. Recovery is no guarantee of stability and often TIAs are precursors, sooner or later, to full-blown strokes, so he was going to hospital.

When he was able to communicate properly he told us that he’d had a TIA before and this clinched it. He was also hypertensive at over 190 systolic. His ECG was anomalous; left axis deviation, wide QRS complexes, deep q waves, T wave inversions in all chest leads and very tall R waves. These anomalies are seen with early-onset MI, so I wasn’t sure whether we were looking at another problem – he had no chest pain.

He was ‘blued’ in, as is required and by the time he got there he was losing the ability to speak properly again. This deteriorated in Resus and it was clear he was having another TIA. At least he was in the right place at the right time.

Jumping on your bed and smacking your head on the bedstead is not usually a reason for calling an ambulance – unless you are a student and you think your friend is about to die as a result. The 24 year-old girl had nothing more than a scratch on her temple after flinging herself on the bed and missing it entirely. ‘She was going to faint’, said her friend when I explained that the wound was minor. This was me being told just how seriously I should take the 999 call. The likelihood of this injury becoming a major issue when it gets to hospital is slim to nil; thus I will see her sitting in the waiting area later on... probably hours later on. A crew took her away because this was given as Red – ‘not alert after falling’. There you go - that's me told.

In a very posh hotel a French lady vomited in her bed as her friend looked on helplessly. She was suffering the effects of a viral infection I would guess; she had a high temperature (39c) and was tachycardic (pulse rate 129). She wanted to blame food poisoning and it can’t be ruled out but my money (none of which I will actually pary with if proved wrong) is on a virus. The crew came to take her away for confirmation and I chatted at length to one of the Hotel's security people about becoming a paramedic.

And continuing with the theme of fast heart rates, a 24 year-old woman collapsed in the street after feeling dizzy and faint. As she sat on the pavement in the rain, I asked her a few questions and got the bottom of the problem – she had SVT; a heart condition that causes fast and sometimes dangerous arrhythmia. She’d had an operation to destroy the aberrant cells responsible and to help her pacemaker get its act together but now she was experiencing another rapid heart rate episode. Almost as soon as the ambulance arrived, her pulse settled and her heart rate normalised. This is called a paroxysmal SVT and it may just be the result of her adjusting pacemaker or it could mean the operation, called ablation, hasn’t been successful.

An off-duty nurse (allegedly) called 999 to report a drug overdose lying in the street in Soho, so I went to investigate. The caller (the nurse) refused to go near the patient or to stay on scene. This, I think, is suspect. Medical professional have a duty of care and if he/she didn’t want to go and check the patient’s status, he/she shouldn’t have bothered identifying themselves in the first place.

I trundled around in the rain, with blue lights on and apparently nowhere to go, searching for the elusive ‘man on ground’. Rain-sheltering folk and diners were bemused and confused at my 2mph crawl up and down and then again from end to end in a bid to ensure that I didn’t miss anyone. I called the search off after a thorough tour in which even I got bored. I have to assume that the ‘overdose’ had got wet, got up and got himself somewhere dry. Somebody with sense at last.

And finally, as they say... off to a local and well known hostel to sit on the floor and chat with a 35 year-old man who was depressed and so took 12 Codeine tablets (he claimed) with alcohol. He lost his girlfriend to drugs recently and simply doesn’t know how to cope. In a ‘there for the grace of God’ frame of mind, I talked to him at length but he got no BS from me and I didn’t try to patronise him. He was genuinely depressed and so, as soon as the crew arrived, off he went for help. I honestly felt for him.

Be safe.

Saturday, 15 May 2010

The tummy ambulances

Day shift: Nine calls; five by ambulance; four by car.

Stats: 3 abdo pains; 1 alcoholic fit; 2 head injuries; 1 unwell; 1 allergic reaction; 1 ?TIA.

I don’t want to say it’s typical... but it is. Abdominal pains at work – very common, especially in the low-paid services sector. So it didn’t surprise me that an employee of a posh club in the West End had done nothing about her tummy ache and vomiting, even though it had started last night and persisted until this morning. I wasn’t shocked that the 26 year-old had, instead of calling in and saying she was ill, wandered into work despite her discomfort and I didn’t feel any emotion about the fact that, although it didn’t merit one last night, an ambulance was now required to take her to hospital because now, suddenly, it was deemed an emergency.

She got me and the car.

The next abdominal pain was at home and I had no contact with the 63 year-old man complaining of it because a crew arrive with me and I left them to it.

Abdo pain number three was being attended to by a cycle unit but he thought I’d be best suited to transport the 22 year-old man from his place of work to a place of treatment (i.e hospital). Again, the patient had no medical history whatsoever and the pain had been going on for some time but he still went to work with it and took nothing to relieve it. Again, he wasn’t vomiting and again he was perfectly capable of walking to his GP or up to A&E with it. Alas, again, the emergency services were drafted in.

At a police station a 25 year-old man sat in his cell, shaking and vomiting into polystyrene cups (as you do). He was an alcoholic and his overnight stay had produced a reasonably predictable affect on him – he was going to have a fit. The custody nurse called an ambulance for him and I was sent to check on him. He had his seizure while I was there and it lasted about 2 minutes, after which, and during his post ictal confused state, he tried to throw one of the cups full of vomit and phlegm over me – luckily he grabbed the only empty cup on the floor. To me it was like a Lottery win.

Large Department Stores are going to call ambulances for most injuries, regardless of how minor they may seem because they want to feel that they’ve covered themselves. So, I was off to a very minor scalp wound, which couldn’t even be bothered to bleed properly, after a 28 year-old woman had the misfortune of receiving a glass picture frame on her head from a height of about two feet when it fell from a shelf she was perusing. The frame shattered on impact but she wasn’t knocked out and had been lucky that the height and speed of the falling item wasn’t greater (weight of object, approx 2kg - speed, approx 2kph, therefore energy received = 4 units). Still, she had to have her scalp looked at and I took her to the nearest A&E waiting area.

‘Generally unwell’ tends to mean many things to us and this is the term we’ll apply to things such as food poisoning, where the symptoms are there but the evidence is lacking. Thus, the 29 year-old woman who had been vomiting, had diarrhoea, fainted twice and now had abdominal pain, was given this relative term for my report. She was in bed in her hotel room, husband on scene, and was confused about her condition because every time she thought she was finally over it, she’d throw up or faint again. She’d been out and about on various trips around London but had come back to the safety of the Hotel room to call an ambulance. She’d had pasta in the Hotel restaurant the night before and I know that the management of these places get nervous about the possibility of a link between their food and a sick guest, so as soon as I was shown in (via the back door), the two managers scooted away, lest they overhear something undesirable.

An ambulance arrived for this patient, even though she could really have travelled for two minutes in the car to hospital.

An allergic reaction, consisting of a widespread urticarial rash and itching next and the 24 year-old woman was at work when it started. She’d had a veggie burger and thought that may have been the cause of it. Normally she is allergic to a few things, including chocolate, so she has these events every now and then but it had been years since the last one and this reaction was more intense. I took her and her work colleague in the car and she spent the duration of the trip scratching her legs like mad. It made me start to feel itchy as I drove along. Ironically, she was the first Muslim woman I’ve met who was born on Christmas day. I asked if she got extra presents. I know of at least one Jewish person who gets presents on that day!

It seems that for every call I’ve had where I’ve conveyed by car, the next call goes by ambulance, so I wasn’t surprised when the crew showed up for the 50 year-old lady who fell on the underground escalator and bumped her head. I was already walking her up the steps towards the car when they appeared. I could have saved an ambulance on this one but in the end it was probably for the best. An off-duty doctor, a medical student, two members of staff and myriad other people were around her when I got to the bottom of the escalator steps, so I wasn’t sure who was who. I identified the doc and the student and at least one lady who knew her. The fallen woman was weepy and vague; a bit slow to respond at times but I think this was mostly emotional. She was taking anti-depressants and it’s a question I will ask automatically for certain types of behaviour, so that I can rule out the injury as a cause, if not for certain, then as a probability.

On the way up, with the woman tucked inside a chair and the crew attending to her (she had a large closed bump on her head), I asked the lady who’d been holding her and calming her down a question.

‘How well do you know her then?’

‘Who? My mother?’


I thought I was getting home on time but a last minute call came in and I was asked to go to a train station for a ‘man collapsed on train’. The 71 year-old may or may not have been cardiac arrest, such was the confusion caused by the limited information being supplied by those ‘on the ground’ as it were.

When I arrived, it took a few minutes to get to him because he was still on the train and it was at the opposite end of the station. Staff members were on hand to help and I found him on the floor, seemingly unconscious but breathing and with a pulse. He had wet himself and this was my first indication for a possible medical event. He’d open his eyes when I spoke to him but then gone right back to sleep. His friend was with him and he told me he’d just ‘dropped off’ during the train journey and had been like this for over an hour now. The man didn’t know where he was or what was going on and several attempts to communicate with him failed.

A crew was sent but they took a while to get to me and when they arrived, one of them had to go back to the ambulance for the trolley bed and then drive to the extreme end of the station to use the only lift that would accommodate it. This delayed the patient transfer by at least 20 minutes and if, as I suspected, the man was having a stroke, time was not on our side.

On oxygen, the patient became more lucid as we waited and began to understand a few things; who his friend was, where he was, etc. He wasn’t yet fully recovered but he seemed to have no physical deficit and so I now thought he had probably had a TIA. This did not take him out of the woods, however, so I really needed to have him on the ambulance and on his way to hospital as soon as possible but fate and the inadequate planning of the station’s management were to slow things down even more. I was now off-duty as far as the clock was concerned but still on that train with the patient on the floor.

Eventually the trolley bed was brought up and we got the patient onto it. He was now able to stand up and follow simple commands – we got him to the lift with all our equipment and staff in tow but now there was another problem. The lift doors wouldn’t open and we had to wait for a manager (apparently only one holds the key) to get to the lower floor and access it. Another 20 minutes slipped by as we waited and then lost patience. I decided we’d go to the other end of the station and try the smaller lift – the one they’d told us we couldn’t fit into.

After a 200 metre walk, with a trolley-bound, fully-recovered patient, his friend, two staff members and all our gear, we reached the other lift and squeezed in, whether it liked it or not. Once we’d got down to the ground floor, I had to drive one of the ambulance crew to the other side of the station, drop him off at his vehicle, then escort him back round to where the patient was waiting for us. Then we finally got him into the ambulance, did our obs and ECG and ‘blued’ him into hospital. The blue call seemed very moot and pointless after an hour messing around at that station but it had to be done.

The man arrived at hospital looking like nothing had ever happened to him. He’d reported headaches for the past week and if he’d just had a TIA and recovered, it meant he was possibly heading for a full-blown CVA, so we still did the best for him as far as I’m concerned but it was like Keystone ambulances and we all felt let down by the train station management – there was no plan for emergency patients; no exit route, no access for trolley beds and then no escape when we needed to get going. If we’d been resuscitating this patient, the situation would have been intolerable. I guarantee you they have an excellent fire plan though.

I went home grumpy an hour and a half later.

Be safe.

Monday, 10 May 2010

Routine calls - not always what they seem

Now we know where all the drunk donkeys go!

Night shift: Five calls; four by ambulance; one by car.

Stats: 1 NPC; 1 ?MI; 1 eTOH with VT; 1 faint; 1 assault with ? # nose.

My first call of the night was a no patient contact (NPC) because another FRU was already on scene for the 25 year-old female who fainted, so I left a few seconds after arriving.

Occasionally, we get what I call ‘bum-biting’ jobs; that is a call where everything looks routine and then the patient goes off on you suddenly, thus clinically biting you on the behind. My next call was to a 71 year-old man who had fainted; he was lying with his feet raised on the floor of an office, looking very pale indeed and sweating all over. Of course, this is significant but he was pain-free, had no cardiac history or any significant medical problems and he looked as if he was recovering. But alarm bells ring when a patient is slow to get their colour back and continues to sweat... and offers information you didn’t ask for yet, like ‘I have no heart problems’.

When the crew arrived I told them what I had and gave them my obs, which were normal and minimal because I’d only been there a minute or two. On the way down to the ambulance (in the lift), he stopped responding and lost consciousness and I had to keep his airway stable as we continued to wheel him to the vehicle. He had a pulse and was still breathing, so it was prudent to get him where we could do the best for him immediately, rather than stop, unload him and start wasting time. Then he had a ten-second tonic seizure, usually a sign of brain hypoxia and usually transient. He came to just as we were getting him into the ambulance.

His ECG was all over the place but there was no ST elevation, so we took him to the nearest hospital, rather than a specialist centre. His BP had dropped and he was bradycardic now. His pallor never improved and so I got my bag out, put a line in and prepared for the worst but he was talking lucidly to the crew and, although changes began to appear in the ECG, they weren’t yet decipherable as one thing or another, so I gave him no drugs and no fluids.

He was ‘blued’ in and the doctor couldn’t make head nor tail of it. I’d mentioned the possibility for a ‘silent MI’ for this patient – a pain-free heart attack – and it began to look likely. After three more ECG’s in Resus, the elevation in his chest leads began to increase and his T waves were inverted. I left the doctor to work out what to do next as she drew blood from his radial artery for confirmation. These changes are often very early signs of MI.

The next patient asked if there was a charge for him to be taken to hospital. He was drunk and vomiting in the street. His friend was with him and he too asked if a fee was involved for his mate’s care. I wonder if he’d have just gone home and sobered up, rather than accept our invitation to go to hospital if there was a charge.

Just as well he didn’t because after I’d let the crew (the same crew from the previous call) take over his care, one of them came to the car to tell me the patient had VT, a rapid heart rate. I went to see the ECG that was now being done and sure enough his heart was racing at almost 200 beats per minute. This lasted about five minutes before resolving itself and settling down to 90 bpm, with occasional dropped complexes. I have to admit reflecting on how easy it would have been to pack him into the ambulance like any other drunk and ignore alternative possibilities for his pale, vomiting presentation. The crew had been smart and quick-thinking to have realised his pulse wasn’t as it should have been because ECGs are not routinely carried out on inebriated young people, especially in the West End. I hadn’t even started obs on him myself because the crew were arriving with me and the man had busied himself by vomiting over my boots when I approached him but I still worry that this could have been missed if I had passed it over as ‘just another drunk’.

Clearly, he was drunk but equally something potentially dangerous could be going on with his heart. He didn’t take drugs and he was adamant on that point, so, unless it was just one of those anomalies that happen to young people, he may have an underlying cardiac problem that needs immediate assessment. We ‘blued’ this man in.

A 63 year-old Chinese man fell in the bathroom, knocking his head on the tiles and his anxious family called an ambulance because he was unconscious for a while and seemed to stop breathing. When I arrived, he was sitting in a chair in the little room, conscious and breathing but looking decidedly pale, so as soon as the crew arrived, he was taken to the ambulance and off to hospital. There was no bleeding and he had no significant medical history but his condition warranted further investigation.

Later on, an assault outside a club produced two patients, one of which was hyperventilating and was taken by ambulance – the other was left with me to convey in the car. This 22 year-old man had a possible broken nose as the result of being kicked in the face as he lay on the ground. It’s obviously very big and very brave of someone to kick a man when he’s down; let’s face it, he’s on the ground and no threat whatsoever, so what’s the point in risking a criminal record by continuing the assault?

Be safe.

Sunday, 9 May 2010

Professional medical abuse

Night shift: Six calls; three by ambulance; one taken home; one left with police; one left at scene.

Stats: 1 fall; 1 eTOH; 1 lost Alzheimer sufferer; 1 assault; 1 alcoholic fit; 1 sleeping drunk

Sometimes you show up on a call and the little detective in you tells you it’s not quite what it seems and so it was for the 27 year-old man who was reported to have neck pain after a fall. He was also reported to be ‘not alert’. We were expecting a long-fall trauma but we got a grown man on the carpeted floor of his flat, wife nearby showing no emotion whatsoever, and a crew already there trying to establish how he could have dropped from a few feet and sustained a serious injury.

He could move just fine and, although he insisted he had pain high up on his spine, when he was told we’d have to turn him and go through the usual motions for spinals, he suddenly recovered and got up himself with no more than a red face to show for it.

His wife was short with me when I asked how the chair he’d fallen from had come apart – ‘must I repeat everything’ she said. The chair’s seat was wedged inside the frame and that can’t happen with a simple fall. The emotion in the room was neutral but there was that aftermath-of-an-argument-or-fight feeling about it.

We left the crew to it but I pointed out a stethoscope lying on the table, thinking it may belong to one of my colleagues but we discovered that it belonged to the patient. He was a doctor and she was a nurse.

Over on the other side of society, where alcoholics sleep on the street, a 45 year-old Lithuanian man was found sleeping on the pavement and a MOP panicked and called an ambulance. A PCSO was on scene and I quickly woke the man up and had him sit upright to keep him awake. After an initial introduction of ‘f**k off’ from him, he settled down and when the crew arrived and nothing was found wrong with him, except alcoholism, I assured him that, yes, we would be taking him to hospital - for that I got a kiss on the back of the hand. Verbally abusive or not, it was cold tonight and nobody deserves to lie out in it all night if there’s a chance of a few hours in a warm A&E waiting area. I haven’t changed my tune, incidentally but until we get a Government with a spine and stop allowing people to come here and do this, then the NHS will just have to continue dealing with the problem at our expense.

Here’s a heart-warming story. An 80 year-old man was found wandering the streets -completely lost and confused - by a pizza delivery driver who had the good sense to drive him back to his workplace and call an ambulance. We arrived to find the man in a small takeaway shop, free pizza in front of him and bemused staff on scene.

In a few minutes we’d established that he was indeed, confused. ‘How old are you?’ he was asked. ‘Oh, about 28', he replied. He was sprightly for 80 but he wasn’t fooling anyone. So on closer investigation I found a tag around his neck that informed us he was an Alzheimer sufferer and that he often forgot his address. His son’s telephone number was on the tag and I called him to advise of his father’s whereabouts. The son told me that the address he had given us was where he lived during the war and that it had been bombed out – his family details; ‘I have a wife and two sons at home’, was incorrect because his wife died five years ago and his two boys were all grown up – he lived with only one of them.

So, I drove him back to his home and we were met by the family. His son said he’d never have been able to find him if the pizza man hadn’t been so kind. ‘I put a sign on the door telling him not to go out and that he lived here’, he told me. The old man had left his tea on the table and wandered back to the street, over a mile away, where he lived during the blitz. Hopefully when he does it again, another good-hearted person will find him and get him home safely.

Then there was the grown man who claimed he was attacked in a bar by a knife-wielding madman. We arrived as he was being pinned up against a wall by police officers after he’d given them abuse about the fact that they were not taking him seriously. He insisted on being taken by ambulance to hospital for his injury - this amounted to a grazed knee that a 3 year-old wouldn’t shed a tear for – oh, and a torn shirt, courtesy of whoever scuffed his patella in anger. He’d been thumped and he didn’t like it, so he took his rage out on the cops (and they liked that even less) and the system. ‘I pay my taxes!’ he said. So do we and, on this occasion, police were going to give him his money’s worth. We left him in their care.

A fitting 45 year-old was an alcoholic with freezing hands. Two cops were with him; they’d watched him stagger and fall to the ground shaking. We found him sitting on a bench – still shaking. He’d lost bladder control and had probably suffered an alcohol-withdrawal seizure; it’s the price they pay for their excesses unfortunately. But again, he was cold and hungry and he got an ambulance to take him to safety, warmth and hopefully, a sandwich.

In the wee small hours a Red2 for a 35 year-old man found in the street ‘not waking up’ had us running with a crew to a possible cardiac arrest but when we got there we found a slumped, drunken man wearing a cook’s apron outside a fast food shop. PCSO’s and police were on scene but none of them had successfully roused him from his slumber. So, after the student paramedic had tried the old ‘eyelash’ trick and found that he was a faker, he was given painful stimulus to make him open his eyes. It worked instantly (oh, and the painful stimulus we give is perfectly legitimate in these circumstances). He sat up, opened his eyes and gave us all grief. He didn’t want to go to hospital and, after a few precautionary checks on his vital signs and BM, he was left in the same spot with a foil blanket around him to serve as a heat trapper and an ‘LAS aware’ sign to prevent a repeat of the unnecessary drama that had been caused.

Be safe.

Saturday, 8 May 2010

Searching for the elusive job

Night shift: Ten calls; one by car; one declined; four left at scene; four by ambulance.

Stats: 1 RTC; 1 purple; 1 abusive person; 1 chest pain; 1 faint; 1 eTOH; 1 eTOH head injury; 1 infection; 1 head injury; 1 assault.

My assigned student paramedic is with me tonight and tomorrow so I get to watch someone else doing all the work and so we stopped to assist at a RTC involving a cyclist and a car. The cyclist slammed into the parked vehicle and took out the back window (see pic). An elderly couple were just leaving it to go to the theatre and were made late by the incident, which was not their fault. The cyclist wasn’t wearing a helmet but only seemed to have cuts to his face, caused by the shattering screen, so he was incredibly lucky. Still, the biker on scene decided, quite rightly, that he needed to go in a collar and board to hospital and I made that an excuse for the student with me to get some practice.

A call to a large theatre for a 26 year-old man ‘not responding’ took us to an obtuse and verbally aggressive man who was sitting on a chair in the canteen area, ignoring the security men who were trying to help him. He seemed drunk but a tag around his wrist told us that he’d been out, probably all night, at a place where they sold alcohol and where drugs like GHB were probably available, so his attitude and demeanour could be explained from that clue alone. When he started to get obnoxious with the student ('you're just a bloody jobsworth') I intervened and stopped the process. I asked the security guys to deal with it because the man had no medical problem and didn’t want us to help him even if he did. I wasn’t going to sit there and pander to his aggression as if we were just puppets in his little play. So, we left and the security men took matters into their own hands.

For the sake of practice, Control are sending me wherever necessary so that the student paramedic can get valuable skills in, so I was sent more than 3 miles to a ‘not breathing’ call for a 32 year-old woman who hadn’t been seen for a couple of days, only to find a confusing situation. There were two calls in the same street; a RTC with a child in the car and the one I was tasked to. The street soon had four or five yellow LAS vehicles and a police car in it.

The patient we were going to deal with had been dead for a long time and so all my student had to do was go through a few checks (rigor, staining, temp) and leave the EMT on scene to complete the paperwork. He had arrived earlier and there was no need for us to hang around. The student paramedic needs to get tubes and needles, drugs and fluids practice, so we are searching for the right calls.

Then onto a chest pain in the City and a 56 year-old Asian lady had nothing more than an anxiety attack in a club. She’d found a mouse at home earlier and had chased it around until finally capturing it and this, she told us, was the cause of her stress. She’d had chest pain, radiating to her neck and then began to lose her vision. All the signs of a faint after stress in fact. A crew arrived and we went through the routines required of us; ECG, BP etc and this lady was as fit as a fiddle (why do they say that?).

An Italian man with a history of PE fainted in a restaurant and I had to control the little mob of family and friends that gathered around him, including, strangely, their family GP who just happened to be joining them on their London holiday. Only one person could speak English and the student paramedic was using her as a translator. The GP was difficult to keep back because he was interested, obviously, but the patient’s stress level was being affected by the constant pawing and staring, so I asked for everyone but the translator to clear a space – not an unreasonable request. There were so many of them; I think they’d taken over the entire Italian restaurant.

He was left with his family after thorough checks and a normal ECG. He’d fainted and nothing more. His GP could keep an eye on him.

The next patient punched me in the jaw as I tried to take his pulse, so I suddenly became less interested in those around me who were claiming he was ‘ill’ and ‘can’t breathe’. The 39 year-old was drunk among many other drunks at a family party in which small children and babies were witness to his thrashing on the floor antics, coughing and general abuse, which he threw at myself and the crew on scene. His trousers were around his thighs and I asked that the kids be taken away, especially the one being held by its mum as she stood close by to get a better view of what was going on in the little community hall.

The police were called because, despite our gentle attempts to calm him, he was only interested in throwing his fists at us. I won’t tolerate this and so he was tied onto a trolley bed and escorted out by cops and the crew. He was completely unmanageable and seemed to be suffering nothing more than hysterical intoxication. After the incident I took myself and the student back to the station where I inspected the state of my molars. I'd lost a bit of filling, so I'll live.

The 23 year-old girl who fell down six steps at a night club, smashed her face and head and then walked out to be met by her (equally drunken) boyfriend was taken away by cab because neither of them were interested in her health and welfare. In fact, the crew that arrived with us were left standing on the pavement without acknowledgement. It’s going to be a night of ignorance.

Off to the East for a 66 year-old man with a leg infection who was feeling very ill. He had a high temperature and shook continuously; he also had leg pain higher up than the infection itself, so my guess is that the problem is spreading. The crew arrived with us and he was taken to hospital.

Now, it’s all very good getting dressed up in school uniform and prancing around a disco when you’re all grown up and want a bit of fun but to start fighting in the street and end up getting arrested is just stupidity - especially when dressed like that. Alcohol and testosterone has a lot to answer for.

An 18 year-old lad tried to fend off the lecherous advances of several thuggish ‘schoolies’ towards his mum, who he had brought along, dressed appropriately in short school skirt, shirt and tie of course, and got beaten up for his trouble. He suffered minor head injuries and was knocked out for a few seconds. Meanwhile another fight kicked off as we arrived and another young man got his nose busted out of that one. In the middle of it all, with twenty or so drunken, uniform-clad teenagers and men behaving badly, a single police officer tried to keep the peace but was forced to draw his baton to defend himself against what looked like an angry mob that was about to turn on him.

Broken nose man walked away for some reason and I called an ambulance because it just felt like more trouble was coming. Sure enough, with the head injured man in the back of the car and the broken nosed one in the ambulance, further little scuffles ensued and more police arrived to sort it out. One or two of the less intelligent among the mob got arrested because they just wouldn’t or couldn’t control their aggression. I have a bad feeling that this lot, as they disperse into separate groups, are going to create problems later and elsewhere. I'm guessing they behaved like that in school for real.

And fights broke out here and there in the West End as expected, so we were sent to an assault in which a 25 year-old Latvian man was allegedly robbed of all his hard-earned cash as he made his way to the coach station for the trip home. He had superficial facial injuries but complained of C-Spine tenderness and that meant an ambulance, collar, board and a trip to hospital. When the crew arrived we were all pretty cold; the night got progressively bitter temperature-wise and the cops and CID on scene huddled around as we secured the injured man. He began to fit, however, making life difficult for us – then he recovered for a short while and repeated the seizure again, just as we thought the worst was over.

At last he was taken into the ambulance where he began to talk again and the crew decided to move away in case he had another fit. I took my freezing fingers back to the car and the student paramedic followed with her paperwork and obs.

Drunken idiots decided to knock down a barrier set up to channel traffic into one lane because work was being done on the road and I didn’t notice that they were flat on the ground until I saw how close I had come to falling into the deep, five foot square hole that was now exposed and ready to injure or kill a driver or pedestrian if they just happened not to be concentrating. I roped in a PCSO, my student paramedic and a couple of volunteering road sweepers to help me get the barrier back up. The last thing I needed was a late job back there for a ‘car down hole’ or ‘person impaled on spike down hole’.
And the fight with the schoolies meant we didn't get called on the near-fatal stabbing in Piccadilly Circus that would have given the student some real practice.

Be safe.

Friday, 7 May 2010

Elephants in London

Lots of these beautiful elephants are dotted around London. Apparently they will be auctioned off for charity. I might buy one for Harry :-)

Night shift: Eight calls; one by car; seven by ambulance.

Stats: 3 eTOH; 1 faint; 1 eTOH with head injury; 1 chest pain; 2 eTOH with cuts; 1 unwell patient.

If you like to calculate my job number and verify it with the stats then this will confuse you because the first call of the night was for two drunken men who were found lying in the street. One of them was hugging the other so tightly that he couldn’t breathe properly and one of the cops who found them worried that he may have breathing difficulties – he was gasping for air when relieved of the dead drunken weight of his equally inebriated friend. In fact, one was the uncle to the other, or so he slurred and it took less than a minute for them to work out I was from Glasgow, so Uncle Drunk called me a Scottish c*** and Nephew Drunk told him to stop it – a balanced family I felt.

A crew arrived and took them both on board, the cops man-handling them as if they were naughty children, which, in essence, is what they were. They hadn’t done any harm apart from being nasty and sort of racist (like I really cared) and so a trip to the great NHS drunk tank was required.

Later on a 32 year-old man collapsed, presumably fainted, in a restaurant. He was recovering in a chair when I found him and he’d been placed there by the Manager. Unfortunately, he was seated with two men who knew nothing about him and they were rather nervous looking. It can’t be comfortable to have booked a table, sat down, prepared yourself for a lovely meal with your friend only to have an unwell man fall down in front of you and then recover in a chair at your table while you try to think about useful or engaging conversation as a means of distraction.
I apologised to them for having to carry out my obs there but he looked ill; diaphoretic, weak and pale and his blood pressure was low, so I wasn’t going to ask him to stand up and move to the table where his actual friends were. Luckily, the restaurant Manager found another table for the two guests. In fact, she moved the guests from the table next to me too – I was probably bad PR.

An ECG in the ambulance revealed a few anomalies that I thought he should get checked out (long P-R and wide QRS) and his friends travelled with him after settling their bill. This man had fainted before with no explanation and yet his GP – from what he’d told me – had done very little in the way of checks. No ECG was carried out and his blood pressure wasn’t taken. So, he probably hadn't gone to his GP.

I caught up with my son, who is working nights this weekend too and we ran on the same call to a 70 year-old man who’d fallen in the road and had a head injury. Police were on scene, as well as a host of helpers/witnesses and the man was standing against a wall with his bleeding head and a cigarette in one hand. He was very, very drunk.

On the ambulance he threw up and at first it looked like blood had been vomited – the witnesses had reported him ‘coughing up blood’ on the pavement when they brought him out of the road – but it was only red wine. He’d been drinking the stuff all day and had intended to make his way home by train to the West Country, where his wife waited for him. He was in no fit state for that trip and his ECG was abnormal too, so he went to hospital.

On a train, a 36 year-old woman developed chest pain. She was a known asthmatic but she gave the train guard a fright and I was called to meet the train when it arrived to check her out. The crew arrived with me and we found her panicking inside the carriage. Plenty of rail staff surrounded her and she certainly gave the impression that she was having a cardiac event, except that she had various histories, including depression and anxiety that made the possibility of a heart problem less likely and panic more likely. Her ECG was normal and, although she insisted on puffing on her inhaler needlessly, she wasn’t having any problems with her breathing. In fact, the over-use of Ventolin was probably exacerbating her condition. Oh, and she’d downed a bottle of wine earlier, so she was quite drunk and that didn't help.

If you drink too much, you are likely to fall down and if you do that in the wrong place, you may end up with a scar or two for the rest of your life. That way, I guess, you can mark up your jolly nights out in style – permanently. The next patient, a 29 year-old woman, tumbled drunkenly onto the pavement and got herself a bump to the head, a deep cut to her hand and an even deeper laceration to her left breast – just how she managed that is a mystery and I didn’t want to pry, so I got her into the ‘Booze Bus’ which was on scene a minute after I arrived and then I had to argue with her boyfriend and brother because they were insisting on jumping into the ambulance with her without invitation. The cuts to the patient were the result of alcohol but the minor altercation that ensued with her posse was just bad manners.

Another drunken lacerated person cut his hand somehow while drinking with friends in a club. The 30 year-old was shouting abuse at someone when I was led to him in the kitchen, where an on-duty nurse had decided one of his cuts was deep enough to warrant a trip to A&E for closing. We need a 24-hour Minor Injuries Unit in the West End. I’ll open it myself if I get the time and money to do so.

I took him in the car once he’d settled down and I’d dressed the wound, which was quite deep but not life-threatening by any stretch of the imagination. His anger had been directed at someone in the kitchen who’d given him a hard time over the insignificance (in their opinion) of the wound.

I was approached by a young woman and asked if I could ‘go check’ on her drunken collapsed friend while on standby in Leicester Square. What’s worse, I think, is that I was also approached by a Spanish man who said ‘four friends, me and we go to Kilburn Park. How much?’ I don’t mind being mistaken for a taxi but I object to the insistence that I am even when I have pointed out, repeatedly, that, yellow car or not, I won’t be taking them anywhere.

Anyway, the drunken girl was slumped in a doorway and her sister and a whole load of other mates were hanging over and around her. I could hear the young men lecturing her about what an ‘idiot’ she was drinking like that and ending up so drunk she couldn’t be woken up. ‘She needs to learn how to drink’, said one of them. Ironically, that’s not what she needs; she needs to learn how not to drink.

I called in the Booze Bus and she was taken away for her own good while her brother took photographs of her for posterity and a young man impressed his girlfriend by sitting on the bonnet of my car until I told him in no uncertain terms to get off. Taxis get more respect.

The last job was a late one and I went to check on an 81 year-old man who had a UTI but was still unwell despite completing his antibiotic course. He was in bed and his worried wife explained that he had a medical history that included heart attack and stroke. The poor man looked pale and weak, so when the crew came in I left him to be taken to hospital in the hope that his infection could be sorted out properly.

Be safe.

Tuesday, 4 May 2010

Happy Birthday Scruffs!

Just for the Scruffy fans out there, here he is, now aged three.
Handsome, isn't he?


Monday, 3 May 2010

The lazy paramedic (me)

Day shift: Four calls; four by ambulance.

Stats: 2 head injuries; 1 ? fracture; 1 unhappy alcoholic.

Nothing for me to do until the afternoon and, ironically I got a break before my first call for a 76 year-old woman who tripped up and fell, landing on her head in Oxford Street. A crew had just arrived and, after a cursory check of her condition and obs, I left them to it. Still, it gets me out, doesn’t it?

So, I trundled off to Trafalgar Square and found myself parked up during a political rally being held by the LibDems. It wasn’t until a few minutes had elapsed that I realised I was actually acting as more of a promotional device for the party than any of the flags and banners. I was sitting inside a bright yellow car. Until, that is, I got my next call for yet another fallen lady in Oxford Street – this time a 90-odd year-old woman fell and broke her head open at a bus stop. It was a nasty, large bruised bump but she was conscious, alert and moving about. Her daughter was crying and understandably worried but a crew joined me within seconds and we had her in the ambulance and in safe, capable hands. She’ll be fine – she hadn’t lived that length of time just to be beaten by a pavement.

Another fall and this time the patient, a 45 year-old woman, fell down half the flight of stairs on a double-decker bus. She told me the bus had suddenly moved as she came down with her daughter and she’d lost her balance as a result. I found her lying on the floor with a sprained ankle that may have been broken – sprains can disguise more serious structural damage to that part of the leg. A crew turned up because there was no way she’d be going in the car and we splinted the limb, moved her awkwardly to the trolley bed (thank goodness for ramps) and into the ambulance. That was the extent of my job and I left it to the crew.

Finally, and with a mere ten minutes to spare before I was due home, I received an apology and a late job. Luckily it was just up the road from the station. Unluckily, it was one of the local East European alcoholics who was lying outside a motel for no good reason, so an ambulance was called.

I spent ten minutes with him and got nowhere. I knew him and I knew he spoke and understood English but he just wasn’t playing ball. He wanted to go to hospital, that’s all, and when the crew arrived he was still silent until he got inside the ambulance (where I knew he would find his voice). Then he told us that he was lying there because of trouble in Bosnia. He was a Serbian who’d fought in that conflict. We had to remind him that the war was over and that, even if it wasn’t, there was no medical emergency associated with it in the UK. I left the crew to listen to his story because I already knew it.

Be safe.

Saturday, 1 May 2010

In the Times

I'd been told by a Times insider that my blog was going to be featured in their Top 40 today (online) and in their magazine tomorrow. I'm very proud to have been included in the list.