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.


Becca said...

Very very lucky escape!

Vogel at Strawberry Yog had a remarkably similar experience.

Anonymous said...

Hi Stuart,
I have always wondered do you call an ambulance if someone faints?


Xf said...


That depends. Strictly speaking anyone who loses consciousness, however brief, should be checked out in hospital (an ECG will be needed) but a recovered faint could just go to their GP or visit A&E, rather than call 999.

Repeated or prolonged faints are worthy of a 999 response.

If someone faints, give them a minute to come to; then twenty minutes or so to recover fully, advising them to see their GP as soon as possible. Otherwise, if you are concerned, call an ambulance.

Anonymous said...

Thank you very much for that information, I have always wondered what to do and this has helped me significantly.


jkiev1 said...

I have to say, the old man was very lucky to be where he was, it was smart thinking for the wife though I would have thought the Ambulance station would usually be empty with all of your wonderful "I hurt my finger calls". But I hope he made a full recovery from that ordeal.

I also would have thought that the office with the pillow; most first-aid rooms would have pillows *shrugs* or maybe someone just likes having naps in their cubical when they can. I also laughed quite a bit at you "hugging a not-awake stranger" and could imagine the photo of that.

You seem to also have a lot of old buildings that like falling on people over there in London.

Also last note: I wanted to ask if you/your colleges get annoyed with self-harm incidents that you get called out to?

Another good blog :)


Xf said...


We try not to get annoyed with anyone... :-)

jkiev1 said...

Is it still frustrating? knowing it is self-inflicted and that there are other people out there that are desperate for medical attention without actually causing it on themselves on purpose?
Though I do understand the nature of "non-judgment" especially with what you do, certainly it must be disappointing or something.

Fiz said...

I have to say, when my husband was in a well-known Cambridge hospital with a pneumothorax, the man in the bed next to him was a would- be suicide - he was working a long way from home and had had a phone call which had ended in an "I'm going to leave you" threat from his wife . The staff were absolutely horrible to him and he had no visitors at all. I used to talk to him as well as my husband and to try to reassure him that there was always something good around the corner and that suicide was not an answer, and he seemed to agree with this. His wife did eventually turn -up and there very first thing she said was "How could you do this me?!" I wanted to slap her, and I have often wondered how things turned out for him, poor man.