Wednesday, 30 June 2010

Combat medic

Night shift: Eight calls; one declined; two left at scene; one false alarm; five by ambulance; one by car.

Stats: 1 faint; 1 RTC bus v sped; 1 head injury; 2 cut feet; 2 eTOH; 1 assault with head injury.

A 26 year-old gave blood earlier in the day and then fainted when she was queuing with her friends at a restaurant. She was recovering well when I arrived and her obs were all normal. She didn’t want to go to hospital and she didn’t need to, so I asked the restaurant people if they could put her and her friends at the front of the queue (she needed to eat) and then got her to sign my paperwork, leaving her in the care of her mates.

No sooner had I finished this call when another came in – a 22 year-old man had been hit by a bus on Oxford Street. When I arrived, there were a few PCSO’s on scene and a grey car parked in front of a bus. The windscreen of the bus had a large bulls-eye on it – two in fact and I was shown inside to where the patient was sitting, chatting merrily away with one of the PCSOs.

He’d been walking across the road and got hit by the bus at around 20mph; his head and shoulder hit the windscreen, thus the two bulls-eyes. All he complained about was a sore shoulder. His head was marked but there was no bleeding and no other visible injury of any significance. His neurological signs were good and he generally looked okay. I spent a long time with him because there were no ambulances available and in all that time (30 minutes) he showed no sign of deterioration.

I had explained to him that he would be ‘boarded’ when the crew arrived. I’d already put a collar on him but he needed to know that it was all precautionary. I got another FRU colleague to assist me while I waited for an ambulance and while he held the man’s head still, I asked about the grey car that was still in front of the bus. Police had arrived by then and Oxford Street traffic was being controlled. I was told that the man was hit by the bus, flew across the road a few feet and then hit this car. I looked at the side of it and there was a huge dent in the back door. If this young man escaped injury he was very lucky indeed.

When he finally got to hospital, boarded and immobilised, the doctor gt a little excited about the impact speed and the fact that he'd been thrown across the road and into a car, so he was rushed into Resus, looking bemused. Later on he was walking out of the hospital and thanking me as I entered with another patient - just goes to show you, doesn't it?

The second trauma call of the night was to a 33 year-old man who was hit by a chunk of brick that apparently flew off some covered scaffolding as he walked innocently underneath – and not directly underneath either; the only way that bit of masonry could have reached him was if it had been lobbed or kicked. He had a head injury and I found him sitting at a tube station entrance near the scaffolding. Two witnesses told me what happened and the works manager, who came out after the incident, was also hanging around, although he was very quiet about it all.

I asked for police to come and check it out because I had concerns about how this brick had flown off the scaffolding and what possibility there might be that another would follow. From three or four floors up, one of these missiles could kill someone. The site Manager was very cagey, to say the least and the police found him a little fidgety about the whole incident.

I asked for an ambulance and got the patient on a board; I wasn't prepared to take any chances with him. The same doctor took delivery of him at the hospital and he must have thought I was deliberately bringing in walking-talking serious stuff.

Later on a 27 year-old woman cut her foot on glass – she was walking barefoot in an underground station and thought she may have stepped on a broken beer bottle. The undergrounds staff called an ambulance (even though there was a first aider on scene) and all I had to do was listen to the woman, who was a soldier apparently, and her three mates, laugh about the fact that I would take her to hospital if she wanted me to.

I put a dressing on it and she said she’d either just leave it or go and see her doctor. I think they’d all had a drink but her underlying point was made – a 999 call for a cut foot? Crazy, surely? In what other country on Earth (apart from the obvious few) would that be considered an emergency to life?

So, another cut foot made me look silly again but this time, the 25 year-old woman hadn’t called and neither had the train station staff. The first aiders were dealing with a very minor laceration to the bottom of her foot but some strange person, who wouldn’t stop pestering them apparently, went off to the nearest payphone and dialled 999 – thus I arrived ready for the emergency. This type of behaviour is akin to taking money out of our pockets and chucking it down a drain – it’s so easy to do.

Another easy thing to do is get drunk while on antidepressants, fall to the floor of the toilet, retch, foam at the mouth and struggle to vomit on an empty stomach... apparently. The rescue mission took me to a bar where an off-duty nurse (yes nurse) was carrying out vital research for the NHS. The crew was on scene just ahead of me (‘cos I went the wrong way and got there late), so I helped them get her onto the chair and up the stairs to sanctuary. ‘Why am I like this?’ she asked as she lolled around trying to throw up. It would have been easy to say ‘because you have had too much alcohol’ and that would probably have been true but factor in the drugs and she may just have been having a good old fashioned reaction to them - either way, she should have known better but she didn’t get a leaflet or a lecture; she got Metoclopramide and a free ride to the nearest A&E.

As Soho racked up another couple of drunks, fighters and arrested wasters, I was asked to go up north to visit a man who’d been introduced to a bottle – in the face. I was told to ‘stand by’ for police. I have no idea what this means any more – do I travel towards the call and then wait somewhere? Do I wait where I am and then go? It all used to be so simple but now it’s all got a bit stupid. So, I waited, pressed my ‘please talk to me’ button and waited some more. Then I waited a bit more... and more until a driver pulled up alongside my car and told me a man was lying in the road, so I called in a running call and went to check on him.

The young lad was half-in, half-out , body on the pavement, legs in the road. Any vehicle coming along and cutting up the corner would also have cut his limbs off. A lady had stopped to help him but she couldn’t wake him up (everybody knows only the LAS can wake people up, right?). She put his keys and his wallet into his rucksack and zipped them away. Then she left when I arrived and after she’d told me this.

I woke the man up and told him where he was. He seemed surprised. ‘I’m very tired’, he said, eyes half shut. ‘Well, go and find somewhere safe to sleep... not the road’, I replied, eyes wide open. He shook my hand and staggered off into the early morning. My God, it’s July already – where’s my life gone?

Assaults involving gangs that pounce on individuals and stamp on their heads are among the worst calls to go to because there is always an element of anger and shock at the brutality of it. My next patient, a 34 year-old gay man, was sitting on a step with his boyfriend and two police officers. He’d been set upon by four people, punched, kicked and thrown to the ground. Then they’d stamped on his head so hard that the boot print could clearly be seen on his cranium. He had other cuts and bruises but it was the mark on his head that concerned me most.

I couldn’t get an ambulance and he was stable, so I took him and his partner in the car. They swore a lot but I guess this was all anger and frustration.

Two for one next when I went to a call on which police were standing guard over two semi-conscious drunken males, both from the same group of friends, who’d collapsed in the street and had been there so long they’d both become hypothermic. No ambulances were available and there’s no Booze Bus running (this is exactly what it exists for), so with the prospect of waiting a while, I covered them both to keep them warm and plumbed them both in to keep them hydrated and to dilute the alcohol in their blood. The Summer has arrived and this is what we are all up against for the next few months. It will get much, much worse when the schools break up. It can be like treating in a war zone.

I got two ambulances after a while and my patients were carted off one by one to the great drying-out centres we call hospitals.

Be safe.

Sign up and ask about stuff

The Guardian is running an online live Q&A discussion for those of you interested in becoming a paramedic - or for those of you that just want to know what it's all about.

I've been asked to participate and will be around (in the ether) to answer questions and chat. Feel free to get involved; it's running from 1pm til 4pm on Thursday, 1st July - here's the link for advanced questions -

I'll 'see' you there!


Tuesday, 29 June 2010

The electric fan - a medical miracle!

Night shift: Seven calls; one by ambulance; one taken to a nearer tube station; two left at scene; three by car.

Stats: 1 faint; 1 DIB; 1 near faint; 1 tachycardia; 1 swollen foot; 1 chest pain; 1DOAB.

A muggy start and a trip out to help a fainted pregnant woman. The 25 year-old collapsed in the stupid heat of the underground as she made her way home. She was recovering well and being fanned by a staff member when I arrived. I took her to a nearer train station so that she could avoid sitting in the heat again for too much longer. I also advised her to get a fan and use it when she travelled. Things are set to get much worse over the next month or so.

Just as pizza was a possibility, I was dragged away to the north into an ugly, badly planned estate for a 72 year-old swearing man with DIB; he had a long history and was feeling the effects of the weather, just as thousands of others with COPD and asthma are, or will soon. The crew arrived within a few minutes and he was their patient from that moment on. He continued to swear and bemoan the people in charge of the estate... and doctors who told him that the electric fan in his house was as good as extra oxygen. I wonder if NASA knows this; maybe astronauts should be going into space with a little personal fan to keep them alive?

I’ve deliberately separated the faint from the near-faint because this second swooning call was an almost faint and not the real thing. The actress from the show ‘Love Never Dies’ was in the dressing room up in the top floor of the Adelphi Theatre when she collapsed and had to be laid down with her feet raised to avoid a little catastrophe. The pins and needles she felt were the result of her body panicking and the swoon may, or may not, have been caused by the heat, pregnancy, a virus or the height at which she and her colleagues had to dress and undress. This was a bit like the underwear shop I visited last week (not personally but on a call) – I was focussed on the patient and trying to avert my eyes, lest I see something I shouldn’t ought to (as they say on the boards).

The patient (let’s call her ‘Potty P’, which is what I dubbed her anyway) was taken down to ground level in the lift and out through the eager autograph-chasers at the Stage Door. I took her to hospital in the car.

Thankfully, it is quieter tonight, so the next call came in an hour or so later – it was for a 22 year-old male with ‘heart problems’. At that age, I expect to find nothing wrong with the patient, or drugs are involved – or panic but sometimes I get someone with a diagnosed condition, like this one. He had Cardiomyopathy and was worried about a tachycardic event he had but that had now settled down. He didn’t want to go to hospital, he just wanted checked out and reassured. Personally, I’d rather he’d gone to hospital but it’s his choice.

His ECG was all over the place but generally, his vital signs were normal and he looked fine, so I left him with the paperwork and a copy of the ECG. As I looked at the ECG and considered it he said ‘What looks strange to you guys, is normal for me’.

As soon as I was ready, another call came in and I was off to a police station to see a woman about a foot. She was a homeless person who’d gone to the police and reported her injury – a swollen foot – and this triggered a 999 call. I can’t believe we run on lights and sirens to things like this; it’s ridiculous because I’ve been to a few calls from this location and I had already sensed what was coming. Homeless people use the police to get an ambulance so that they can be taken to hospital and sleep in the waiting area.

The 33 year-old woman was sitting on the police station steps with a police officer looking after her. She had a very slightly swollen foot but this had been a problem for her for a number of years. Now she couldn’t stand on it, she claimed. This was strange because she walked – practically ran – to the car when I said I would drive her to A&E.

To be honest, I have no problem helping a homeless female to get off the street and into somewhere safe but if she’s been homeless for a ‘long time’ as she stated, then I suspect there’s a reason for that.

Another young person with chest pain but no related condition was the 24 year-old who sat on the pavement with ‘ten out of ten’ pain and asked a passer-by to call an ambulance. He denied any drug taking but admitted he’d been drinking ‘a little’. He also said he’d had this problem before – a fast heart rate – and I did an ECG in the street to get to the bottom of it.

He was non-diaphoretic and seemed perfectly comfortable, even though he had the equivalent level of pain as, say, a dust mite giving birth to an elephant. So, I took him to hospital in the car and my critics will all gather around the pond to have a go no doubt. The fact is, his ECG wasn’t screaming anything and he just didn’t come across as real. The hospital was two minutes away and I followed my instincts.

And my instincts were also followed for the 60 year-old male, ‘unconscious’ on a bus. The old drunk-on-a-bus (DOAB) card is being played every night at the moment... two reports in the space of a few minutes when I went to this one and I think, as is the norm, there will be a rash of DOAB calls throughout the Summer.

He was easy to wake and a bit stubborn but he got off the bus after a five minute debate in which he slurred stuff at me and I replied, hoping that I was making sense – ‘get off the bus’ seems pretty straight-forward, right?

Be safe.

Friday, 25 June 2010

Staff sickness

Day shift: seven calls; two treated but not conveyed; one left at work; four by car.

Stats: 2 hypoglycaemic; 1 unwell; 1 cut foot; 1 abdo pain; 1 psychiatric; 1 dizzy; person.

Before we had a chance to get north and breakfast, a 34 year-old diabetic was found semi-conscious in bed by his girlfriend and she called an ambulance because she didn’t know what to do with him. He’d never shown her how to measure his blood glucose and had never told her what to do to treat him if he became low.

We gave him Glucagon and he was back to his normal self within fifteen minutes. A few tablespoons of honey helped to keep his sugar level up and we left him at home with his partner (and some advice on what to do next time). 'I'm too good for him', she told us, as if we needed to know.

Immediately after this, when back on station, we were asked to check on a Control colleague who was feeling unwell. She just needed her BP taken and it was fine, so she was left at work. It's one of the ironies of working for a large ambulance service like this that those who work for us still have to 'call and ambulance'. They don't even get a discount.

A 25 year-old woman who cut her foot on the escalator at an underground station could (and should) have hopped herself across the road to A&E if she felt the need. Instead, we were called out and I drove her around the corner. Please be sure to let me know that an ambulance should have taken her instead.

An hour or so past before we encountered our next patient, a 28 year-old restaurant worker who had her boss call an ambulance for ‘chest pain’. She had abdominal pain and a momentary fainty feeling, so an ambulance was not required and we took her to hospital where, for reasons I cannot fathom, the A&E department was full of people – it seems everyone is calling 999 today just so they can end up sitting in a corridor waiting... just as they would if they’d just walked themselves in.

Hot weather increases instances of hypoglycaemia in diabetics, so I wasn’t surprised when we received our second such call in the afternoon. The police had called us on this one because he’d been acting strangely and when questioned, had been vague with them. He did ask them to get him to McDonalds, which was nearby, but they decided he was too unwell.

A crew was just ahead of us and the student paramedic worked with them to get the 42 year-old man’s blood sugar back up from the low two’s but, even after three Glucogels had been given and twenty minutes had elapsed, the man’s BM remained low.

He had been swallowing the gel too fast - it would have gone straight to his gut with very little buccal absorption, so giving him Glucagon would have been an unnecessary intervention. It was best to wait or give him a small amount of IV glucose if his condition didn’t improve. But he caught everyone out by suddenly becoming lucid when he was about to be taken into the ambulance. His recovery was starting and it would, once the sugar he’d been given, continue until his BM was normal or high-normal.

He was given chips to eat by a friend and he turned human again. Then he went on about his day with his mate.

A call to a train station for a 49 year-old female who ‘had a nosebleed’ and who stated she had a blood disorder, turned into a bit of a joke when my student went missing trying to find the patient and I bumped into her by accident (the patient) on my way out of the station to find the student. I heard a voice say ‘are you looking for me?’ and saw a large woman sitting on a bench nowhere near the location given (thus my lost colleague). She told me she ‘needed’ an ambulance because she had suffered a nose bleed and it had stopped and she had a blood disorder... also that she suffered depression and had just come out of jail – she’d been arrested for fighting. ‘A man beat me up’, she said. I have to say I doubted that.

Opinions aside, we took her to hospital and left her in care because there was no evidence upon which to base a clinical referral at all.

Another LAS colleague felt dizzy when, once again, we visited HQ on an errand. I’m sure they see us and get ill – we make them sick obviously. The woman was suffering from giddiness and vision problems and her ECG was abnormal (but not enough that it merited a panic). She may just need her eyesight checked or she may be having a more significant medical event. We took her to hospital just in case.

Be safe.

Thursday, 24 June 2010

No-one's talking sense any more

Day shift: Six calls; three by ambulance; two by car; one with police.

Stats: 2 unwell adults; 1 chest pain; 1 ? circulation problems; 1 abdo pain; 1 eTOH.

The unwell man was a 69 year-old who’d been lethargic, weak and sick for a while until his wife decided enough was enough and called an ambulance. He needed one and, despite the call being read as a possible car journey, a crew turned up and he was quickly taken away. His breathing wasn’t good and he looked off-colour.

The other unwell man was a 39 year-old at work who decided he didn’t feel well and had his bosses call an ambulance two hours later. He was the silent, emotional type who doesn’t talk much and doesn’t answer questions and the crew was understandably stressed that they were getting nowhere with the details. We get this a lot and it’s okay if you are very ill and can’t speak but it is kind of selfish to have an ambulance crew attend and then not even talk to them when they need to know what’s wrong. We can’t use psychic abilities to guess what’s up and we can’t treat things that are emotional or psychological.

After an hour or so of sunning ourselves on Trafalgar Square and running back and forth with radio swap problems, we were sent to a 64 year-old woman with chest pain. She walked out of the callbox and over to the car before we had much of a chance to park up. An ambulance joined us very soon after we landed, so the student had very little to do, although she stayed with the patient and crew to get the ECG results.

A 20 year-old female with Guillain–BarrĂ© syndrome told her boss she suddenly couldn’t feel or move her leg, so we were called to deal with it. At first it looked as though an ambulance would be the only option because she had varicosed veins and stated she couldn’t weight bear at all. We were in the basement of a ladies underwear shop and we waited for a while before I finally decided that, once I’d learned all I could about some of the stock, courtesy of the Supervisor, and had gleaned info on what the Hell a ‘Tankini’ is, we could probably wheel her out on a chair with castors and use the lift to get her to street level. Then I’d physically lift her into the car. That was the plan and that’s how it was executed, much to the amusement of the customers.

After taking a man to the local police station after he told us he’d been hit by a motorcycle (he’d swapped details with the guy and let him leave the scene), we went to a 25 year-old who’d fainted and who now had abdominal pain – a very common combination on a call. She was fully recovered, if she’d passed out at all, and was still complaining of abdo pain – an ambulance wasn’t required, so when the crew turned up, after they’d been cancelled, they were happy enough to leave it with us.

We took her with a colleague in the car and had to stop when we were informed by kindly drivers that the hatch had been left open. Luckily, nothing fell out. My student doesn’t want me to report that it was her fault for leaving the hatch open. But it was. So there :-)

A useless journey for a 55 year-old drunken woman next and police were on scene standing over her when we arrived. Another FRU was also arriving and so we were very much surplus. It’s been a day of duplicates and communication drops.

Be safe.

Tuesday, 22 June 2010

Return of the professional timewaster

The elephants are going to auction and before they leave, they are 'on parade'

Day shift: Nine calls; one woken up; three left on scene; one referred to GP; two by car; two by ambulance.

Stats: 2 sleeping persons; 2 abdo pains; 1 headache; 1 RTC with 3 patients; 1 back pain; 1 nosebleed; 1 RTC with ? spinal.

The first call of the morning cost me ten seconds of my life to get to – the bus in which the ‘unconscious male’ temporarily resided was across the road from where I had parked. It took another ten seconds to shake him awake and walk him off. The well-tanned man apologised and groggily made his way to wherever he had planned to be this morning; he wasn’t a drunk and he wasn’t homeless – he was just tired and the bus driver, being told not to take any risk, had done nothing to wake him up.

A request to travel further south than normal took me to an underground station where a 27 year-old female was suffering abdominal pains, dizziness and nausea. She had recently been diagnosed with an Ovarian Cyst and Endometriosis and by the time I arrived, she was getting better. The pain had eased and she felt less sick than before, so I did the paperwork and spent twenty minutes chatting to her, ensuring that she didn’t actually need to go to hospital because she didn’t want to.

I left her in the very good hands of the London Underground staff and they ensured she got home by taxi. Hopefully, she will seek advice from her GP if this pain returns.

Another female abdo pain with a gynaecological aetiology came in just as I was about to enter the Post Office. I am trying to mail out a package and I need to do it today but, as Sod and his laws will confirm, it will probably be a failed mission because calls are bound to come in just as I walk towards the entry door.

I took the 26 year-old to hospital and then up to Emergency Gynae. She has already had a miscarriage and this is her second. She was, understandably, very upset. I felt a lot of sympathy for her of course because I think women experiencing this ‘common’ problem are generally left to fend for themselves.

The 32 year-old female with a headache who called an ambulance from her workplace probably has anaemia (she has a history). She told me she felt weak, dizzy and tired. I empathised – I feel the same a lot of the time, except for the dizzy bit, unless you have a point of view on my personality.

I left her with her colleagues and advice to go and see her GP as soon as possible.

Not far from where I had just been, if you know what I mean, a multi-casualty, walking-wounded call was generated when a 13 year-old female – part of a school group visiting from Germany – was hit by a moped and the driver and his passenger were thrown off onto the road. All of them sustained very minor injuries; grazes to various exposed body parts, and so I asked for one ambulance and the police. No helicopter or line of vehicles for this one.

I dressed the graze of the moped driver and the teenager was checked out in the ambulance while her teacher chatted to her and made sure she was okay, which, apart from the emotion of being hit by a vehicle, she was. She was left in the care of her teachers as her friends clicked away on their cameras and used their mobile phones to record the mini spectacle. No doubt it will all show up on You Tube. No doubt she will be more careful to look both ways next time too.

After a break I was sent out to deal with a back injury that sounded as if the patient would need an ambulance. Instead I found a 25 year-old Masters student sitting against a wall complaining of muscular pain that developed hours earlier when she was cycling. To be fair to her, she didn’t call an ambulance for it, the security and teaching staff of the college did. She was prepared to make her own way to see her doctor about it.

I took her in the car to A&E and she sat waiting, with other minor ailments, for what will probably be a good few hours.

A regular caller, timewaster and self-harmer is back on this ‘patch’ – I’ve known him for almost five years and have often referred to him in these posts. He’s been gone for about a year but now he’s up to his old tricks and there seems nothing we can do about it. He generated a call for a ‘person lying in alley with bleeding nose’ and when I got there he was crying out to ensure that people would take notice of him and call an ambulance. This is what he always does and he self-harms to ensure he gets a response. There is never anything truly wrong with him. He’s the same person that got turfed out of hospital as soon as I got him there a few shifts ago. It’s all getting very boring with him.

The crew that arrived didn’t know him and I gave them the SP before they got near. I didn’t want to patronise them but if they don’t know him they could be in for a shock – he will throw blood at you, spit at you and attack you if given the chance. He’s not a nice man at all.

He claimed he’d fallen from a height, then changed his story to one in which he was attacked by someone he owes money to. It was obvious from his position and the blood smears on the cardboard he was laying on that he had cut himself (broken glass all around him) then rubbed his nose across the cardboard for dramatic effect. One day very soon, this guy will take a resource away from a dying person - or will be the dying person.

As the day closed I was sent to a park where a 7 year-old girl had been knocked down by a bicycle. The bike had hit her at around 20mph and she was instantly rendered unconscious for two minutes, according to witnesses (and there were plenty of them). The little girl was Arabic she and had a large family with her. The witnesses reported that as soon as she was hit, family members lifted her up, hung her upside down and began shaking her in an effort to bring her back to consciousness. This report appalled me because if the girl had a neck injury, the poor cyclist that had hit her (she ran out in front of him and he was in a cycle lane), regardless of how you judge his speed in a public park, would be blamed when the cause of any harm to her spine could be traced to the actions taken by her family afterwards. This is a very bad approach to first aid - it is deeply ignorant.

The girl was conscious but in some distress when I got there and an ambulance was with me because we’d arrived at the same time to find nobody to guide us in (nobody official anyway) and the only gate we could use was locked. So we drove all the way to the top of the park and went back to the incident scene the long way – rubbish really.

She was collared and boarded and blued in as a precaution. She’d been unconscious and that meant she’d hit her head hard enough to cause potential damage, so she would need to be treated seriously until cleared at hospital.

I have a lot to say about the backward way in which 'first aid' is practised by some people. If you have kids, go and learn some first aid – properly. Stop living in the Stone Age and get educated.

Finally, on the way back and with little time left on the clock, I was asked to wake yet another sleepy-head who was on a bus. This time the vehicle was parked up on Hyde Park Corner and I went around it twice before seeing the bus I was going to. Traffic is so heavy in that area that getting a good look at anything near the pavement when you are solo is almost impossible.

Anyway, I woke him up and he got off the bus, complaining bitterly about being deposited on a hard seat at the bus stop.

Be safe.

Monday, 21 June 2010


Day shift: Four calls; three by car; one by ambulance.

Stats: 1 unwell adult; 2 vertigo; 1 ?PE.

The day started with warm sunshine and the return of the commuter run for the first day of the week. I’m working a few days of overtime this week, so will be on for seven days straight on this tour. I’ll be tired at the end of it, so my writing may slope off the page by Friday.

It starts with a request from a motorcycle colleague to transport a 41 year-old lady who began to feel unwell on her way to work. She had been suffering from a chest infection recently and vomited earlier. We found her sitting on a step with the MRU paramedic, looking under the weather (the patient, not the medic). It was a short hop to hospital, so, after a handover to the student, we delivered her to A&E.

We were then asked to investigate a 39 year-old female who’d started vomiting and felt dizzy at a children’s hospital. He child was waiting for an x-ray and her grandfather was taking care of her as mum languished on the bed of one of the medical rooms awaiting our arrival. No ambulance had been dispatched and the staff in the ward had been warned they may have to wait an hour for one but the problem was easy to solve. I gave her Metoclopramide to stop her from vomiting and then we got her to the car and took her to A&E. She had a history of Vertigo, so there was no clinical reason for her to wait for an ambulance.

This was closely followed by another Vertigo-related vomiting call; this time for a 36 year-old male at work. He hadn’t yet thrown up and he wasn’t given anything because his main complaint was dizziness. That soon turned to throwing up when he got into the car but he wasn’t nearly as bad as the previous patient.

A 20 year-old female called us from a train station after experiencing chest pain that she’d felt before – a few times in fact, when she’d suffered multiple Pulmonary Embolisms (PE) – okay, it’s emboli in the plural but I’m talking in the collective here. Anyway, grammar aside, she refused to go in the chair when the crew arrived and had no interest in the trolley bed either, even though she still had chest pain. A few paramedics have been sacked and struck off for walking a chest pain that subsequently collapsed and died, so she was asked again to allow the use of the chair but she was adamant. So, the PRF was signed to verify that she had refused this important element of her care.

She also refused to get her backpack off and to have her belongings carried by a colleague. She was very stubborn and I’m not sure if she had issues with us, herself or her fears. She got into the ambulance at least but the struggle to get her to comply for her own sake continued and I left the crew to it.

Be safe.

Sunday, 20 June 2010


Ghostbusters visits the town and everybody gets scared...
and calls for an ambulance.

Day shift: Four calls; one assisted-only; one by car; two by ambulance.

Stats: 1 fall; 1 head injury post ?EP fit; 1 ?miscarriage;1 fall with facial injury.

A quiet start to the morning until an assist-only call for a very, very large man who’d fallen and couldn’t get up. The combination of Ankylosing Spondylitis and sheer mass made the job of getting this man off the floor and back onto his bed impossible without a special piece of equipment called a Manger Elk.

Two police officers and a crew were also on scene and this was not the first, or second (or third) time we’d been called to get him up when he tumbled. He had no injury and insisted that all he wanted was to be put on his bed but that was easier said than done. He was naked, except for a towel around his waist and when he was finally raised on the Elk, he left a messy cargo on the device as he stood and balanced himself against his walking frame. I could see the police officers wincing at the sight but the three ladies with me; two paramedics and my student, cleaned the faeces from the Elk and sat the man back onto his bed without a word. The excrement had smeared his carpet and sheets. Clearly he couldn’t take care of himself and nobody else was looking after him.

I completed a form that lay near his bed; it was from the Council and it was requesting information on a any help he may need for disabilities. The patient didn’t seem to know it was there or had ignored it, so I explained what it was and filled it in. Then I got him to sign it once he’d read it and took it with me in the freepost envelope. I mailed it for him later in the shift so hopefully something will be done about this.

An investigative run to an up-market apartment block (pillars, marble, 24-hour concierge), for a 28 year-old epileptic who may or may not have had a fit but whose loved ones found him with a head injury in any case. The blood had crimsoned the inside of his baseball cap but there was little in the way of a significant wound to his head when inspected. It almost seemed as if someone else (a guest bleeder perhaps) had bled into his cap and left him on the floor afterwards. He had no memory of falling, fitting or bleeding.

A crew arrived and so, despite the intriguing nature of this call, we left them to get on with it rather than bumble around being useless. I did, however, manage a set of obs and a quick listen with my stethoscope... on the teddy bear belonging to the small boy of the family. He was not impressed, even though I told him that his bear would live. Some people, no matter how small, have no sense of humour.

Around the corner, in a hotel, a 22 year-old Lithuanian staff member complained of sharp abdominal pain and some PV bleeding. She is three months pregnant and clearly worried that she may have lost this, her second child. It sounded like no more than ‘spotting’ and this is normal during the early stages of pregnancy but we took her to hospital just in case – after I’d had to reverse down a winding ramp into the guts of the hotel that is.

An elderly man with suspected Alzheimer’s fell on the pavement and smashed his face. He was found by passers-by as he lay face down in a small pool of blood. His cuts were fairly insignificant but he’d managed to get here from somewhere, so the student para asked him a couple of standard questions.

‘What day is it today?’ she asked.

‘The day after yesterday’, he replied.

‘Do you know where you are?’

‘Yes, I’m right here’.

He was either playing with her mind or he was just a cleverly confused person. We opted for the latter and that’s where the suspicion of his wandering escape came from... he told us he’d come from ‘a home’ and we think he meant some kind of care home. He’d probably wandered away from his place of safety, shuffled along the pavement and eventually tripped over with no hope of stopping his descent.

His ECG was abnormal, showing a right bundle branch block (RBBB) so he was taken to hospital by the crew when they arrived – he’d have gone anyway.

Be safe.

Saturday, 19 June 2010

Travel advisory service

... and neither are you lot. Protestors on Parliament Square are giving the place a very untidy look as they rage against things (some pertinent, some not) that will never change just because they are there. Some of them are 'on strike'. Eh?

Day shift: Four calls; one left on scene; one by car; two by ambulance.

Stats: 1 diarrhoea; 1 ? appendicitis; 1 head injury ? TIA; 1 eTOH with head injury.

We were asked to wait in a hotel lobby while the patient, a woman with diarrhoea, made her way from her room to see us. It felt as if we were a taxi service.

When she appeared she told us she just wanted checked out in case she had food poisoning; she didn’t want to go to hospital and thought a quick 999 call and check up would be enough. She and her family were off to Edinburgh later on, so I think she was hoping for a medical miracle or a pocket remedy to stop her loose bowels from giving her problems during the long drive north. Of course, we didn’t give her anything but advice and left her on scene with the necessary paperwork.

At a place where traffic wardens gather for work, one of their colleagues became ill with acute right sided abdominal pain. He’d had it on and off for a while and it had always gone away but this time it was worse and stubborn, so a cycle responder was sent, followed by us in the car.

He had Entonox but it didn’t touch the pain and he could barely stand up, so he got a little morphine and that made him a little more flexible – enough that he could walk to the car anyway. The student paramedic sat in the back with him as his pain level dropped and we took him to hospital for diagnosis. If it was appendicitis, he’d waited too long before getting it sorted.

A few hours passed before we got our next call, which was for a 70 year-old man who collapsed in a pub. He wasn’t drunk and his friend told me he had no medical problems but something had made him fall to the floor, bashing his head and cutting his scalp open.

He was very confused but conscious when we arrived – he was clearly concussed and the staff member who was helping him had carefully taken his false teeth, which had fallen out, and wrapped them in a towel. The missing teeth concerned the fallen man a lot and he quickly replaced them as soon as they were given back to him.

He may have had a neurological event, possibly a TIA, so when the crew arrived, the trolley bed was brought in and he was put on it for the trip to hospital.

A last-minute RTC, ‘lorry vs pedestrian’ turned out to be a drunken man who’d fallen, cutting his head open on the pavement. He staggered around with blood coming out of his wound, claiming he didn’t need any help but he was clearly too drunk to walk. When he tried he staggered into the path of an oncoming car, dropping to the ground in front of it. I ran over, grabbed him and lifted him out of the way. Then we walked onto the ambulance, which had just arrived. He was still being a little aggressive but he'd at least submitted to his weak condition.

Be safe.

Monday, 14 June 2010

Faulty comms

Night shift: Six calls; three cancellations due to comms problem; one no-trace; two by ambulance.

Stats: 1 RTC ? injuries; 1 ? sepsis.

A broken bulb on my usual car meant a change of vehicle and I had my student paramedic with me tonight, so I was hoping to get enough work for her to complete her objectives. Unfortunately, we had a communications problem and the first calls to come through were cancelled because we didn’t receive them properly. Then we got sent to a no-trace for someone stating they had heart problems.

After that we were sent to a road traffic collision and arrived to find the victim walking around with a gang of concerned citizens attempting to stop him. He’d been hit by a van when he walked out drunkenly in front of it but he appeared unhurt. Alcohol can easily disguise injury, however, so the student paramedic got out to stop him moving around and I parked to block the road.

The student had him on the ground and was keeping his neck still by the time I got out to help. The crowd around her was giving her grief and they had to be cleared. Thankfully the cops arrived in time to do that job for us and a crew got to us soon after, so we had enough people on the ground to help the man who’d been knocked down.

Despite the witnesses’ story that he’d been thrown five feet into the air, the truth came out eventually and CCTV revealed that he was hit at fairly slow speed and slid along the road for about ten feet, so he was unlikely to have sustained any life threatening injuries. Nevertheless he was collared, scooped and taken in for checks.

When the light of the morning came up we were sent in support of an ambulance to a 45 year-old man who had DIB. The crew went into the address, followed by the student paramedic, who was going to see if they needed us at all. Ten minutes later they appeared with the patient, strapped to the chair and looking very rough indeed. He was moaning and gasping for breath, very grey and obviously distressed.

The man in the chair was a dialysis patient and something had gone very wrong for him. As soon as he was in the ambulance we set about getting him comfortable and looked at his ECG – he had a fast VT and would go into cardiac arrest imminently by the look of it, so he was hooked up to the defib, which wanted to shock him even though he was conscious, such was his condition. He got fluids for his failing BP and taken rapidly to hospital on blue lights.

He was delivered to the Resus team within minutes and, soon after we left, he arrested. Whether he survived or not I do not know but given his deteriorating state, I doubt he’ll carry on much longer even if he gets away with this crisis. It was a black ending to the shift.

Be safe.

Sunday, 13 June 2010


Night shift: Six calls; one walked off; two (same call) assisted-only; two by ambulance; two by car.

Stats: 1 eTOH fit; 2 falls with minor cuts; 1 dislocated knee; 1 ?EP fit; 1 cold person; 1 fast heart beat.

A regular alcoholic with attitude had a fit in a small green where people lie out in the sun and after I’d treated him with sympathy and reassurance, he pushed me aside and walked off, telling me he needed a cigarette. It was too late to cancel the ambulance and I had to explain the wasted trip to the crew.

This was followed by a call to an underground station where two men had fallen over each other on the escalator. They had very minor cuts to their arms, legs and hands, so after cleaning the wounds up they continued their journey without further harassment from the NHS. Two voluntary services people were on scene when I arrived and they gave me a hand-over but it was as clear as day the injuries were so negligible you’d get worse in your own garden by falling onto a bramble bush – if you have such a thing in your garden.

A dislocated knee in the City next and I was meandering around corridors in a large office building towards the patient who’d swung on a table and lost the stability of his patella whilst working a night shift. He had a history of this and it took no more than ten seconds to reduce the knee (simply by straightening the leg), with the help of Entonox, so that I could take him by car to hospital to have it examined.

Reducing a Patellar dislocation is necessary for pain relief and to prevent further damage to the joint and if the patient is willing to have it done and the necessary skill is applied, it is a very straightforward manoeuvre. After the knee cap slipped back into place he was much more stable and his pain score dropped a few points - job done.

Getting him down to the car was the next problem – we were a few floors up and I had gone through a lot of corridors to get to this room. The solution came squeaking around the doorway – one of his colleagues wheeled in a post trolley and he stood on this as we carted him into the lift and out of the building. Even with a dodgy knee, he could see the funny side of that.

Later on I was sent to an underground station where a 25 year-old was fitting on the platform. The staff members on scene were taking good care of him when I arrived after a long, spiralling walk down the back steps with two police officers accompanying me.

The man had fitted three times for short periods I was told and he was epileptic and diabetic, so I checked his blood glucose and found it to be normal. He was lucid enough and that surprised me because, although his pulse was quite fast, he didn’t look as if he had exerted himself as epileptics tend to when they have fitted.

Then he told me he’d walked out of hospital because the nurses didn’t like him and that rang an alarm bell. He also told me he was on antidepressants, or had been. Then he had one of his ‘seizures’ and it wasn’t very convincing, so I think, as a professional person with the right to make a clinical decision, it was probably best that I decided not to administer anything for his ‘epilepsy’. He’d also been drinking alcohol and that negated drug therapy.

As soon as his ten second thrash on the floor finished he was perfectly lucid and able to answer questions again and regardless of my suspicions, I continued, as you do, to treat him as given, except for drugs of course.

In the early hours I was sent out to check on a 55 year-old man who’d called from a payphone to say he was cold. That’s it – just cold.

Normally this is a wasted journey because the caller usually walks off but after finding an empty phone box I spotted him wandering in my direction. He was shuffling and stooped.

I asked him why he needed an ambulance and he said ‘I just thought a few hours in the Emergency Department might heat me up’. At least he was honest about his reason for calling, so I did him the favour of driving him to A&E. He was cold but not so bad that it warranted emergency treatment. The nurse accepted him and I got a bit of a glance. What else could I do? The man was lost and couldn’t get home to the West Country where he lived in a hostel, so I did the human thing.

At a posh hotel a 68 year-old lady woke up with a fast heart beat; her husband was with her in the room when I arrived and he explained that she was normally fit and well but this had given her a fright. She had never experienced tachycardia before and the reasons for it range from the benign to serious, depending on many factors, including depletion of hormones necessary for the steady functioning of the cardiac electrical system. This is what I believe was happening to her; one of her glands was probably running out of juice, so to speak and, after a more thorough examination and a sound diagnosis by a doctor, she would more than likely be given a hormone to add to her diet for life. It’s common and nothing to worry about.

When the crew arrived to take her to hospital I got a handshake and a thank you from her husband. We don’t get much of that and it was nice to receive it.

Be safe.

Saturday, 12 June 2010

Model behaviour

Night shift: Eleven calls; one arrested; five by ambulance; two by car.

Stats: 2 eTOH;1 fall with leg injury; 4 assaults with facial or head injuries; 1 sprained ankle; 1 hoax; 1 gone before arrival; 1 fast heart beat.

Straight away the West End gave up it’s miscreants before kick-off and I was sent to Soho for a man who was being pinned to the ground by three doormen. He’d got so drunk that he became violent and hit one the security guys. You don’t do that if you have any brains.

Luckily, he wasn’t hurt and I wasn’t required. The police were though and I could tell they were not pleased at being called to him a few minutes before England kicked the first ball of their tournament. I sympathised with their emotions but they were very professional and still managed to call the drunken man ‘sir’.

Of course London Town became strangely quiet of traffic and people when the match started but I was sent to a 67 year-old man who’d stumbled from a bus and cut his leg. I thought it would be a routine, not-needing-an-ambulance-response- type call but I was wrong.

When I got on the bus, the injured man walked towards me with a limp. I asked him to sit down and I had a look at his wound. The cut ran deep into his shin and when he moved it a squirt of blood jetted out onto the floor. He’d cut into his Tibial Artery.

I put a tight dressing on it and took him to hospital. He was stable with no pain and the bleeding was easily controlled – unlike the passengers who appeared from the top deck to get off the bus – they were trailing blood on their shoes before they knew it. I had warned them but they were in too much of a hurry to catch the next blood-free bus.

No sooner had the final whistle gone (1-1) than the onslaught of drunken calls began. A 25 year-old female had her head down the toilet and a complete stranger, who professed to being her new friend, sat with her in the ladies loo of a pub. She was very drunk and had to go to hospital. A 15 year-old in cardiac arrest was broadcast on the radio at the same time which means he’d get a delayed response. Someone else’s life is worth more than the trouble we go to for people who drink themselves stupid.

A 25 year-old Indian student was minding his own business on the escalator of an underground station when he was allegedly assaulted. When he challenged the man who’d punched the back of his head ‘for fun’, he was given a going over by the assailant and his mate. This was a typically nice touch demonstrating the violence and uncontrollable stupidity of certain individuals. A slap on the wrist is all they will get from the legal system (if they are ever caught) and that just isn’t good enough. The poor young victim was physically shaking after the attack and bled from a split above his eye, a split lip which carried on through to the inside of his mouth, and bruises. Shame on those who walk around after such an unprovoked assault.

A cancellation just as I landed on the next call, for an unconscious man (through drink). A crew was on scene and I was surplus, so I went to the next call, for a man who’d sustained a sprained ankle. I recognised the description of a known frequent flyer; I’ve known him for years (as have my colleagues) and he can be violent. Sure enough, he was sitting on a wall with two concerned MOPs standing by. I thanked them and attended to the patient. He did have a sprain but there were no vehicles available, so after a long wait and a lot of entonox, I took him in the car. What I didn’t know was that he had been banned from the hospital, so on my way to the next call, I saw him being wheeled right back out by security.

A hoax call for a 21 year-old that ‘didn’t have anywhere to live’. The call box was missing a caller and so I wrote it up as another waste of valuable resources.

This was followed rapidly by a 22 year-old panic attack woman who didn’t even bother to wait for my arrival. She left the scene and ignored all the call-backs being made by Control.

I watched two young Asian men square up to each other on the street as if they were in a gang meeting. One felt insulted by whatever the other had said and it looked like it could end with someone being badly hurt – this is what goes on all night in the West End on a night like this. Sometimes the atmosphere is great and people are having a good time but sometimes, like tonight, it seems like you are driving through Hell. So, my next call was no surprise – further up the road a 30 year-old man had received a kicking from four men when he got into a fight with one of them. He was punched until his face swelled up like a balloon; he had a nasty bump on his head and his torso was patterned with boot marks where the assailants had stamped on him. The poor guy was terrified after his ordeal, although he had enough energy left to demand that his mate ‘gets them’. He said that in front of the cops and that isn’t a good idea.

An assault on a young gay man was carried out by three or four others, leaving him with a busted mouth. He walked down the road and collapsed onto the ground, smashing his head when he landed. I was told the thud could be heard from across the street. A crowd of people gathered around him as I tried to find out what had happened to him and it all got a bit threatening. A witness told me of the alleged assault and I asked for police to attend. I also got a crew to help me out because I wanted to get the patient off the street and into the ambulance for safety’s sake – nobody was being nice tonight it seemed.

It took a while for the patient to open up and tell us what took place but all he could remember was being hit. He had a large bump to the back of his head and may have suffered a concussion – thus the loss of memory initially. I think he was also in some emotional shock after having been attacked without provocation. I know how that feels.

So-called ‘legal high’ drugs can cause health problems – stimulants designed to make you feel high can be detrimental for the heart, so the 23 year-old female who called us for a tachycardia she brought on herself by taking such a substance, looked sheepish when I arrived, followed soon after by an ambulance crew. Her heart rate wasn’t too bad though but she had chest pain with it, so she had to go. She lives in a very nice apartment building and obviously has intelligence but self-abuse like this permeates through every layer of society I guess. She will survive to do herself harm another day.

A fight broke out between three men and I was pulled back from my end-of-shift mission to deal with the aftermath. All three had been arrested and had minor skirmish wounds but one of them had a deep enough cut to his forehead to warrant a hospital trip. He told me he was a model and was very upset about the possibility that he might be scarred by the injury. It really wasn’t that bad but he cried all the way to hospital in the back of the police van, cuffed and secured. I felt a bit sorry for him to be honest, although he would probably not be given any photographic assignments for the next few weeks.

Be safe.

Friday, 11 June 2010

Head injury

Night shift: Five calls; one assisted-only; one no trace; three by ambulance.

Stats: 1 panic attack; 1 assault with fractured base of skull; 1 fall with head injury; 1 nosebleed.

World Cup nights ahead of me and no student tonight or tomorrow, so I’ll be working for my salary.

The Friday night started with a hyperventilating, panicky 22 year-old who was convinced (as were her work colleagues) that she having an asthma attack. She’d used her inhaler earlier and then gone to work without it – never advisable – only to collapse in a heap with fast breathing and a ‘burning’ feeling in her throat. The recent chest infection she’d had may have something to do with that but I wasn’t going to give her Salbutamol; she didn’t need it – her lungs were clear and her whole demeanour screamed panic.

The crew calmed her down and she was set free into the warm evening air... and back to work.

Immediately after this call I was sent to the rescue of a homeless man who told concerned strangers he was hungry. I was greeted by two guilty-faced women who apologised profusely for 'wasting our time' because the man got up and walked off without a nod or thanks. It wasn’t food he needed – it was manners.

Then, after a short rest, a 30 year-old man was found in an alley with serious a head injury and I was tasked to assist the crew and another FRU pilot already on scene. He was on the ‘scoop’ with a collar in place when I arrived but his condition was dire – blood was pouring from his ear and a large, bloody lump had formed on the back of his head. His nose was broken and blood leaked from that too. He was stable enough though but we knew that wouldn’t last long, so we got him into the ambulance and away to a Major Trauma Unit quickly. Oxygen was all he needed initially and as long as he was breathing and had a decent blood pressure, he would survive the trip.

Allegedly he’d been hit hard in the face and fallen onto the ground with such force that his skull had cracked. The extent of the damage was unknown and only a scan would reveal that. On the way to hospital fresh blood poured from his nose and his blood pressure began to change, as did the nature of his pulse. Significant changes in his behaviour would soon follow and I knew we’d have a combative patient on our hands soon. HEMS was busy and there were no Delta Alpha doctors to spare, so we ran with it and got him into Resus, stable and still conscious but it was touch and go, literally.

To prove that sometimes assumption is an evil thing my next patient, a 79 year-old man who fell at a train station, demonstrated lucidity even though he looked and behaved drunk. In fact, the call had been given as ‘fall, head injury, intoxicated’ but the man had discharged himself from hospital earlier – he was being treated for cancer and was receiving morphine for pain. He told me he was fed up and signed himself out against medical advice.

He had capacity, that much was sure and he denied drinking at all. This was confirmed when I called his sister and she told me he reacted to morphine this way – he would look very drunk and be unable to walk straight or talk without a slur in his speech. I accepted this and managed to persuade him, with the help of an Urgent Care crew, to go to an alternative hospital to the one he’d just left.

He had a minor bump to his head but was not fit enough to go home, so it was a battle to argue the point against his Irish stubborn refusals and his adamant counter-arguments, all of which were sensibly thought out. ‘Look Scottie’, he said, ‘I’m not long for this world and I’ve had a good innings, so I’d rather have the pain than the morphine because I hate the stuff’. How could I argue?

He was a decent, well-spoken man with a great sense of humour in the face of his deteriorating condition and he knew how he wanted to spend the rest of his life. I respected that and I hope he does whatever he wants to do until cancer finally catches up with him. I wish him good luck because that’s all he wishes everyone else.

Not all nosebleeds (epistaxis) are emergencies but my last patient of the shift, a 72 year-old man for whom I was tasked in my last five minutes of duty time (tsk!), was taking Warfarin and had suffered a cardiac arrest a year ago, so his was a special case.

By the time I arrived, he’d been bleeding for 20 minutes but it had stopped. All I had to do was dress it as a precaution and wait for the ambulance to take him away.

Be safe.

Tuesday, 8 June 2010

The law of gravity... and crumbling walls

Day shift: Seven calls; five by ambulance; one by car; one left at scene.

Stats: 1 DIB; 2 faints; 1 chest pain; 1 near-death shoulder injury; 1 epileptic fit; 1 alleged hit and run.

It’s been a while since I’ve had to deal with a proper, true-to-the-call DIB; a lot of our so-called difficulty-in-breathing stuff comes in on the back of benign and non-emergent conditions – like ‘sore thumb with DIB’... that sort of thing. As soon as I saw the 55 year-old man sitting in the passenger seat of his wife’s car, outside the ambulance station from which she’d attempted to get help (nobody home.. all out on active area cover), I recognised how desperate he was to breathe.

The student paramedic got the oxygen out while I started getting to know him and gathered a short history. His wife did the talking because he couldn’t; she told me that her husband suffered emphysema and epilepsy. They were on their way to hospital because he’d been having trouble breathing since the night before but had ignored her pleas to get an ambulance. She’d driven as far as around the corner when she decided to try the ambulance station but had failed to get anyone (for the reason I’ve already given), so I was sent after she made a 999 call as a last resort.

With oxygen and a nebuliser, the man’s saturation level rose from 85% to 94% - if his wife hadn’t called us he might not have made it to the front entrance of the hospital they were heading for. An ambulance was requested and, ironically, one of the crews from the station they’d attempted to get help from, arrived to take him away.

Before the paperwork had been completed, I was asked to go to another call – just around the corner from where I was, so the student paramedic got her first lesson in time/pen/paper management on the car and had to abandon her first PRF and move onto a new document in preparation for the 30 year-old female ‘fainted’.

The woman was on the floor of her office, lying on a pillow (I asked where these come from in offices – it’s like a magical thing; pens, staplers, pillows...). She suffered from PCOS and Endometriosis. She had abdominal pain and felt faint. Her BP dropped when she sat up for us (postural hypotension) and she threatened to be sick a few times. An ambulance was requested because she would probably pass out in the car. She proved this theory by fainting as I held her to get her onto the chair when the crew arrived. I found myself hugging a not-awake stranger.

Later on a 24 year-old man working in a designer clothes shop (that means loud music, high prices and distracting staff members) called an ambulance for left arm pain and upper chest pain that was an exacerbation of his already diagnosed condition – pericarditis. He had analgesia but felt another trip to hospital was necessary, so we took him in the car after checking that he was fit to travel that way. He was and he did.

A fainting female at an underground station in the afternoon came to us on the heels of a couple of cancellations. The 20 year-old anaemic woman was tired by the look of it and all she wanted to do was sleep. As I sympathised with her plight for rest I thought of how tired I felt at times and that calling an ambulance had never been my first instinct. Okay, so the staff called us but they have little choice when a passenger flops to a drop on the train and then insists on lying down even when asked repeatedly not to, while an emergency ambulance student paramedic attempts to get obs from her. She was taken by ambulance because, even though she could have walked up the stairs to the car with us, I believe she would have wobbled and crumpled somewhere along the way.

A crumbling building wall gave us a long and potentially dangerous job next. Masonry fell fifty feet onto the shoulder of a passing woman on the pavement. She only escaped a lethal head injury because someone noticed it coming down and shouted, making her look up just in time to dodge it. When we arrived people were still walking underneath the building as if nothing had happened and the woman was on the ground with MOPS in attendance.

Within ten minutes of arriving and nervously watching for more of the brickwork from above, I was telling people not to go under the building - the student paramedic tended to the injured woman, the street was closed and the fire brigade taped the entire area off. A platform arrived and the fire crews went up into the air to check the wall of this old building, discovering a crack that ran the length of the ledge. The whole lot would fall, if not today then sometime soon, so a surveyor was called and he ordered the erection of scaffolding and a ‘catching ledge’ in case more fell. This building would need a pretty major (and expensive) facelift now.

We stayed on scene with police, fire crews and an LAS officer until the area was deemed safe enough not to produce another casualty. The woman with the injured shoulder and lucky reflexes went to hospital in an ambulance.

As we left the scene, a police officer asked if we could attend an epileptic who’d fitted in the street. Police were with him and the heaven’s opened up as we arrived to help out. The 30 year-old patient was post ictal and recovered fully within a short time but we all got a bit damp as a result of this additional incident.

An ex-con (this we know from the report given by police when they arrived on scene) hobbled up to the car as we sat on stand-by, claiming that he’d just been hit on the leg by a van as it reversed. This van then allegedly drove off but he got the registration number. We called the cops in because it’s a requirement but he was known to them and his history included schizophrenia and legs that had been scarred and mangled by incidents, accidents and self-harm over the years. Therefore, when he showed us a lump of flesh protruding from the ‘injured’ leg; one that contained a titanium tibia, we were rather sceptical about the accident he’d allegedly had.. but we are not to judge and we did the paperwork and all the obs and waited for him to change his mind. This he did when the officers told him to come clean. They’d checked and found a witness who’d stated that he hadn’t been hit by anything.

Be safe.

Thursday, 3 June 2010


Day shift: Four calls; all by car.

Stats: 2 RTC’s - both with shoulder injuries; 1 toe injury; 1 ? CVA.

Another sunny day and a warmer one promised today I think. Another day with my student too and I really don’t have to do much because she knows her stuff and is confident and able. We need a couple of tricky jobs to challenge her but the first call is straight-forward. A 37 year-old cyclist slammed into the opening door of a taxi as the passenger attempted to alight. He was thrown off his ride, landing hard on his shoulder. The bone to kerb energy exchange may have broken something but he was stable and willing to go to hospital in the car. It was a ten minute journey by car or a twenty minute wait for an ambulance coming from three miles away. Police were called and stories were recorded but nobody was blaming anyone else; the taxi driver, passenger and patient all agreed it was ‘one of those things’. Wouldn’t it be nice if we operated on that basis more often?

A short convey for a 40 year-old man who cut his toe on the escalator because he was wearing flip-flops (yes, that’s right – an ambulance was called) should have ended in the local walk-in (or in his case, hop-in) centre; instead I got detoured so far away that I took him to A&E instead. There are too many road works going on in too small an area of Central London for safety. We can’t get from A to B quickly any more.

Another cyclist and another shoulder injury when a pedestrian stepped out in front of him, causing him to brake hard and fly over his handlebars. We arrived to find him and the pedestrian chatting amicably. The 37 year-old (are all the cyclists in London the same age today?) was nursing a painful, swollen shoulder and we took him in the car, rather than tie up an ambulance on a busy day like today – I’m sure someone out there, whose mum or dad was having a heart attack at this precise moment, will be grateful for this decision.

A little false alarm led us to a minor shunt between two vehicles that had originally come in as ‘person trapped’ after a car crash. In fact, the poor chap whose car was dinged had arthritis and couldn’t get out of his vehicle, so the panicking public made it a grade A major emergency and had us, an ambulance and quite possibly two or three other vehicles running to rescue him. HEMS had even been put on alert but luckily they didn’t fly the bird - they don't generally turn up for 'arthritic entrapments'.

A very calm looking but obviously scared 50 year-old sat in his office while we checked him out. His vision had become unstable and he walked as if drunk, mostly staggering to the left. He had no headache, no medical history and his obs were normal (although he was initially bradycardic) but his eyes were doing something strange and I struggled to remember the significance of it. Every time his eyes moved across his head, they pulled themselves back to a centre point again as if he couldn’t keep them still – they were like magnetised marbles being pulled one way and then the other. No wonder he felt dizzy and couldn’t see straight.

I knew this could be related to pressure on the optic nerve and therefore possibly the result of a bleed in his brain, so we acted promptly and got him to hospital while he was stable and happy to be taken in the car. Again, we could have waited for an ambulance but there was no need to prolong his experience and he was in the right place within five minutes.

I was going to research this problem and explain it properly in this post but, after long days at work and by the time I typed it out, I found I couldn't be bothered :-)

Be safe.

Wednesday, 2 June 2010

No rest for the wicked

Day shift: Nine calls; five by ambulance; two treated on scene; two by car.

Stats: 1 RTC; 1 faint; 2 cut foreheads; 1 Hypoglycaemic; 1 sprain ? #; 1 faint; 1 collapse ? cause; 1 hyperventilating panic attack.

I have been assigned a different student paramedic for the next few weeks, so I will be watching more than doing for a while and the first call of the morning was car vs cyclist with minor facial injuries but it was good practice for immobilising a patient.

The cyclist was pushed over by a car as he tried to undertake – this is always a bad idea and motorists tend to get the blame, so I spoke to the driver and reassured him that the man on the ground had minor injuries and that we were securing his neck as a precaution. His bicycle didn’t do too well – the front wheel got crushed under the car.

Fainting pregnant people are common and our next call was to a 23 year-old who’d fallen onto the floor of the building in which she was about to undertake a course of some kind. She was still feeling dizzy when we wheeled her out to the ambulance, so she went to hospital for checks.

Next up, a 7 year-old boy who fell and bumped his head on a corner of the wooden table by his hotel bed. Mum, dad and sis were on scene, as was the hotel manager, first aid kit at the ready. The boy had a superficial cut to his forehead, really nothing to write home (or abroad) about, so he was given a plaster, reassured and left in the care of the best people possible in such circumstances – his parents.

A 50 year-old type I diabetic tested her BM, saw it was 1.5 and promptly ignored it, as you’d expect when your sugar-deprived brain can’t make sense of anything. So, her colleagues called an ambulance for her when she stopped communicating and started to have periodic myoclonic spasms. Her BM was 1.7 when we tested it and it took a Glucagon injection, 23g of gel, one piece of chocolate (sickly sweet) cookie and more than a few swigs of non-diet coke to bring her round again with a BM of 10.8 in 30 minutes. A wee bit high but better high than low I guess. She soon felt her normal self and went back to work with her mates after the drama.

Outside Buckingham Palace, among the crowds of tourists and lovers of all things royal, an 80 year-old lady stumbled on steps, twisted her ankle and landed on the ground. Her family was with her and she was perfectly conscious and able to thump me after a few bad jokes about the Queen watching from her window, etc. It looked like she had a bad sprain and possibly a fracture and when, after ‘dancing’ her to the car and driving her to hospital, the nurse saw it he said it may even be dislocated. An x-ray would sort all that out and the patient was taken to a cubicle to await one.

She was still waiting for that x-ray when we left the hospital to go on our next call.

AS protesters gathered (taxi drivers I think) along main roads we were sent to a 45 year-old female who’d fainted apparently. I say apparently because we never saw her. The crew arrived just ahead of us and I got stuck in an alleyway after taking a wrong turn. It happens.

A cancellation for a fight somewhere in the West End next and we were soon travelling back the way we had just come for a 75 year-old Indian man who collapsed in the street. An army medic was attending, with police and PCSO’s around him when we arrived. The patient was conscious but not completely alert and so an ambulance was requested for him as the student paramedic checked his condition.

The man’s ECG was abnormal but didn’t scream anything obvious. He was taken to hospital for further tests and I think there is a possibility that he’d suffered a cardiac event.

Another child who fell and cut his head open a little – this time the wound would need closing, so he was going to go to hospital but we were lucky to get to him because the over-eager staff member in the McDonald’s told the student paramedic to ‘wait at the side’ so that a queue could form for burgers. The student quickly explained who she was and why she was there but suddenly there was a communications problem – the staff member could not speak English and needed to get a translator so that we could proceed to the 4 year-old who was bleeding. Apparently the only English this person felt she should learn was that single phrase; 'stand to the side'.

Meanwhile, another staff member was so busy taking details ‘for his paperwork’ from mum that she became frantic when her son was led away by the student. We didn’t even know mum was there. The rules are fairly simple; call an ambulance, lead us to the patient and do NOT separate mum from child for the sake of paperwork and covering backs. Oh, and burgers can wait while patients get treated. Thank you Ronald.

And late off, compliments of a panic attack at a university library where a 23 year-old Chinese girl collapsed and ‘couldn’t speak’. She couldn’t speak because she was breathing too fast, shaking like a leaf and generally being upset about something. Her eyes remained mostly closed until we got her to hospital (in the car – no choice, no ambulance), where, when I took her into the cubicle, she suddenly opened them and spoke – ‘what am I doing here?’ she asked. Good question, I thought.

Then she told me she had become upset because of a personal issue and I am guessing it was a male personal issue. I made my exit swiftly in case I became embroiled in some kind of man-hate issue.

Be safe.