Wednesday, 28 July 2010

The cost of other people

Day shift: Five calls; two by car, three by ambulance.

Stats: 1 emotional ? shoulder injury; 1 chest pain; 1 alcoholic; 1 vertigo and ? cardiac; 1 ? # shoulder.

A 52 year-old woman, suffering from depression, cried and screamed in the car all the way to hospital after falling and hurting her shoulder. There was no obvious injury but she was very, very emotional and I sensed much more at play than a little accident.

‘Why are you so angry with me?’ she screamed when I got her to hospital. The fact that I hadn’t been responsive to her when she was given entonox and then demanded a tissue in a scolding, almost childish way, may have given her the impression that I wasn’t pleased with her but I know I kept that to myself.

Chest pain in a 20 year-old builder next. Usually, young people don’t have serious cardiac issues so we normally get on scene to find that it’s a panic attack or something muscular (or an infection) but this lad was as pale as a ghost when I walked into the on-site nurse’s office.

His pain started when he drank water from a bottle after carrying a heavy load with the same arm – so possibly muscular. However, his ECG was anomalous; ST elevation (which could have been high take-off) and an irregular pulse. He was taken to hospital by ambulance to get further checked out.

A bus crashed into a taxi in front of me as I ran on call number three; a 29 year-old alcoholic who stated he was fitting and even specified the hospital he wanted to go to. The crash happened because of this call – the bus was trying to move out of my way and the taxi got hit. For a short time my path was blocked completely. This was Red call, even though I knew it wasn’t in reality and I was still duty bound to get to it within eight minutes. The bus had to reverse and unpin the taxi before I could move again.

When I got on scene I couldn’t find the patient. I searched the street and eventually saw him, still inside the call box, talking to the 999 call-taker. This was ludicrous. He wasn’t fitting and hadn’t been fitting. He was an alcoholic who was trying to get off the street and into the alcoholics’ favourite London hospital.

The guy had cost tax payers thousands - there was the cost of myself, the ambulance and crew, the repair for the damage to the bus and taxi, the lost earnings of the taxi driver and the lost earnings of the bus company; we are probably talking about two or three thousand pounds and that's before he gets to hospital. 'Treatment' will cost another few hundred quid and when he's ready he'll go and draw money from the State to support his drinking... after which he'll go through the same cycle again and again. It would be cheaper to give him an allowance of £500 a week, put him in the best house in London with his freinds and leave him to it.

An ambulance came for him almost as soon as I got him out of the call box and I was asked to assist with a lady who’d fallen down a few steps and hurt her knee. I was there, so why not? The wound was cleaned up and she was given a lift to work (just along the road). At least by doing that I felt I had been called to this location to do something useful.

People suffering Vertigo have a hard time of it – vomiting every time they move and not knowing when it will strike.

Outside a pub a 62 year-old man sat in chair, looking very pale and ill. His friend was with him and I found out very quickly that this ‘dizzy’ call was a case of Vertigo. He’d suffered for years and nobody had been able to find the cause, but his pulse was slow (low to mid 50’s) and I was concerned about that, so as soon as the crew arrived, an ECG was carried out and I gave him Metoclopramide to control the sickness.

His ECG was normal but slow. He was still pale and sweaty and every time I asked him how he felt he said the same thing – ‘not good’. This statement, coming from someone who doesn’t make 999 calls from phone boxes every time he wants to hide in hospital, is ominous and so, without too much fuss, he was taken to hospital.

His Vertigo may have been the secondary affect of a Vagal disturbance or he may have a proper cardiac problem. It was best to get it checked out while he had signs and symptoms that could be analysed.

A second fallen woman, this time a 40 year-old, who tripped over a raised pavement slab and landed on her shoulder, possibly breaking it at the Humeral head, was with police and MOPs when I arrived on scene.

She had a bunch of flowers with her and she gave me them when I got her to hospital, in a sling and attached to entonox, because they’d wither and die as she waited for an x-ray. I gave them to the reception staff – they rarely get the thanks they deserve, so it was a fair transfer I think, rather than pick one patient among many to receive them.

Be safe.

Sunday, 25 July 2010


Day shift: Five calls; two by ambulance; three by car.

Stats: 2 abdo pains; 1 headache; 1 infection; 1 chronic cellulitis.

Pregnancy causes problems as the baby gets heavier. A 33 year-old Chinese woman lay on a first aid couch in a museum as her husband looked on anxiously. She’d developed a sharp abdominal pain and both were concerned that the baby may be in trouble. Her last scan showed the baby to be in a breech position but that can change easily over the next few months. However, it meant that (and palpation of her bump confirmed this), her bladder was probably being squashed, thus the discomfort.

She had complained recently of not being able to urinate freely when she went to the loo, despite an urge to pass more, so a UTI couldn’t be ruled out - this can be caused by hormonal changes leading to relaxed smooth muscle.

I asked for an ambulance, rather than risk the car for her. She’d be more comfortable laying left side down anyway (less pressure on the Vena Cava).

Period pain can also cause problems but generally speaking, it should be controlled by the person experiencing it. Time after time we will be sent on calls for period pain where the female, usually young, has taken nothing to deal with it. So, she goes to hospital and gets a couple of Ibuprofen. This was the case with a 17 year-old Italian tourist who collapsed in the middle of a pedestrian bridge. Her boyfriend was with her and an ambulance was called by a MOP when she seemed unable to cope with her pain.

She admitted herself that it was normal for her to feel like this during her period and, when she’d seemingly recovered, I was prepared to leave her to get on with her day. Unfortunately, she collapsed (not fainted) again, and again... and again, so I took her to hospital in the car.

Green, green, green...all the calls are green. As was this 34 year-old woman with ‘headache and dizziness’. She had her young daughter with her and she was being given a first-hand lesson on how to insist on going to hospital by ambulance, even though you can walk, talk and call every single one of your friends and relatives on the phone as you sit in the back of the car less than a mile from A&E.

Another headache and this time the 30 year-old hotel worker had a high temperature and a sore throat to go with it. He had an infection, possibly bacterial, judging by the white matter on his tonsils, so I took him in the car to hospital. He should have gone to his GP but he’d left it late and his boss dialled 999.

Towards the end of the shift, I was sent to a fairly regular patient (the ill type, not the time-wasting type); an 82 year-old man with Cellulitis. His leg had become worse than usual, with ulcers suppurating so badly that a plastic bag had been wrapped around the limb to catch the fluid and pus running down it. I could smell decaying flesh before I was even introduced to it. Clearly, he was going to hospital in an ambulance.

Be safe.

Saturday, 24 July 2010

Assault and battery

Day shift: Five calls; one false alarm; one left at home; three by car.

Stats: 1 cut hand; 1 elderly fall; 1 ‘accident’; 1 sprained ankle; 1 assault with ?# nose.

The slow-start morning set its pace with a call to a Spa in which a cleaner cut her hand on a shower door that shattered when she pushed it back too hard. I walked in and crunched my way through hundreds of fragments of green glass that had fallen onto the tiled floor; where there used to be a door, two hinges were left.

The 23 year-old woman’s injury was very minor but she still had little slivers of glass in her skin, so I took her to A&E after removing the more obvious pieces, all of which were loose, and dressing her most significant laceration.

Much later on I was given the task of ‘signing off’ an Urgent Care crew that had been sitting with a 95 year-old patient who’d fallen earlier. They’d been on scene with two District Nurses for almost three hours and when I arrived the patient was asleep in bed – fly-catching while resources were tied up – all for the sake of a re-check and signature to confirm the crew had done their job properly. It’s a bit silly because the Urgent Care crews are generally very good at what they do and are more than capable of helping an elderly man into his bed and then leaving him at home with other healthcare professionals on scene. Why I was needed at all (apart from policy) is a mystery.

On my way back along Whitehall I noticed a lone woman sitting in a doorway watching a column of tourist school children walk by. She sat there, cool as you like, all adult and respectable, with her middle finger in the air. She directed this insult to all of the kids as they past her by. She had nothing to do with them and she wasn’t being amusing with it – she just didn’t like them... obviously.

A call to an underground station for a 28 year-old man ‘abdo pain – unwell, soiled himself’ was a false alarm because the staff members that brought him up the escalator explained that only the last part of the call was true – he had soiled himself whilst on the train. Diarrhoea can be a sneaky assassin.

He was covered with a foil sheet and rapidly taken to the toilets for cleaning and changing. I thanked the staff and left before I was drawn into the saga.

You get good at spotting common injuries when you do this job; sprains, for example. I can grade them and make an accurate assumption about whether a fracture is present or not (Ottowa rules). I learned that stuff way before joining LAS but it has come in very handy, especially when I decide to convey in the car.

There was no reason to call an ambulance for the 46 year-old Israeli man who tripped on a step and twisted his ankle as he landed. He was with his family when I arrived and I could see immediately that he had a sprain, so I hopped him to the car and off we went. His wife stayed behind with their two daughters – she didn’t want to upset them with the drama of hospital, which was just as well because the A&E department was packed.

A police call to a theatre in the West End next, where a young security guard was allegedly assaulted by one of the patrons. I walked in to find him nursing a possible broken nose as police interviewed him and other staff members about the incident.

Allegedly the man and his family; wife and two very young children, were a bit rowdy during the performance and were asked to quieten down for the second part. Most of us, I assume, would have acknowledged that request and behaved ourselves accordingly but not this lot. The man threatened the 34 year-old man, using racist language and head-butting him so hard that his nasal bone was forced over to the right. The wife allegedly hit another member of staff as this was happening. It was clearly a family thing; a day out for the kids and a chance to show them what great human beings their parents were.

The poor man was shaken up about this unprovoked attack, even though security is his job. I’ve seen a lot of this now – emotionally upset people who can’t fathom why they’d be hit by a complete stranger for no good reason. I felt sorry for him.

Be safe.

Sunday, 18 July 2010

Only the car died tonight

Night shift: Six calls; two walked off; one by police van; three by ambulance.

Stats: 3 cardiac arrests that weren’t; 1 sleeping man; 1 abdo pain; 1 assault with facial injuries.

When is a cardiac arrest not a cardiac arrest? Most of the time - that’s tonight’s answer.

Red1 no.1 was reported as a 70 year-old male with a head injury in cardiac arrest and I raced to the scene, miles away, only to find a crew already there with a 17 year-old who’d fainted. Mum doesn’t speak English, so the 999 call was always going to be dangerous for us from the start.

Red1 no.2 turned out to be a sleeping man that nobody wanted to touch – he got himself up and walked away as I arrived on scene.

Red1 no.3 took me miles away with an engine running like it has a sore throat (I think the turbo has gone – again – on the car), only to find that a crew was on scene and they had a young woman thrashing around being all dramatic on the stretcher. She was drunk and hysterical. She’d vomited and ‘passed out’ apparently. Vomiting can do that.

I packed the defib away again and cursed my luck for being stuck with this night shift.

Strangely, the fourth call wasn’t a Red1 but the guy was lying in the bushes as if he was dead. A passing driver had stopped and called us but he didn’t want to touch him. So, I gave him the LAS wake up protocol and he told me to f**k off. The guy in the bushes said that, not the passing driver. Just so you know.

I tried a few times more until he stood up as if he was going to land one on me - you know when they stand up so quickly and move towards you - and I honestly thought he might, so I stepped back and waited. He walked away and that was that.

A running call in Leicester Square for a 27 year-old drug addict who had abdominal pain next. She is a local druggie who lives on the street but gives us no trouble at all. Her abdomen was very distended – she looked pregnant with it but the locality of her pain meant her Liver, which was already being destroyed by Hep C, was probably the root cause and fluid was building up in her belly. People with chronic Hep C are vulnerable and can develop a condition known as Ascites and possibly bacterial Peritonitis when their Cirrhosis progresses. A diuretic would be needed – and possibly antibiotics – to treat this but her disease will eventually kill her. Soon enough, on another night shift at another time, she simply won't be there any more.

I called an ambulance for her and she was very grateful to be treated seriously. I don’t know why she thought I wouldn’t believe her. As I said, she never ever calls us unless she is actually ill.

As the morning crawled in and my car continued to misbehave, a call came in for a 30 year-old male who’d allegedly been assaulted by multiple persons in the street. He was smacked in the face, kicked a bit and then robbed. His bloody nose had dripped a trail across the pavement, suggesting that he wasn’t knocked out.

He declined aid and didn’t want to go to hospital, so his mind was changed by the police and by that time I’d cancelled the ambulance, leaving only the police van to carry him in.

Then, inevitably, the car died. On the way back to base and just as I was calling time on the shift, smoke began to emanate from the back of the vehicle. I pulled over, switched off the engine and waited for rescue by my Station Officer. On my way home I passed the FRU, parked where I’d left it and waiting for a low-loader to cart it off to surgery.

Be safe.

Saturday, 17 July 2010

Alcohol and clever people don't mix

Night shift: Nine calls; one left at scene; six by ambulance; two by car.

Stats: 1 ? swallowed cannabis; 5 eTOH; 1 heart attack; 1 assault with eye injury; 1 RTC with broken foot.

Cops were standing guard over a suspected shoplifter who claimed she’d swallowed cannabis. When I arrived, she was sitting in the security room with the contents of her pockets strewn over the bench. She told me she’d thrown it back up and then went on to deny she’d ever had any. The amount, she said, was so small as to be insignificant, although she used less polished terms.

She was probably telling the truth but who in their right mind is going to admit to swallowing a lot of the stuff? She was very upset about going to hospital though. I wonder why.

On the street, outside a decent hotel, a large Glaswegian alcoholic lay with his jumper over his head and a river of urine running from his trousers to the road via the kerb. So, naturally, someone called an ambulance.

I had to act as translator when the crew arrived because the man spoke broad Glaswegian and if you have ever heard it, then you will understand how foreign it can sound. At last, I had a role to play in the drama of the street drunk. Oh, and he was clutching a bottle of very decent Port; not that I drink the stuff but I know it’s not the drink of the masses - least not the drunken Glasgow masses. And he had a takeaway Indian meal in a box all ready to be taken home and eaten. He was obviously on his way back to share a meal and a drink with someone when he stumbled and decided to sleep it off- by which I mean he’d already consumed an entire bottle of Port (there was an empty one on the street nearby) en route.

The crew were novices at Glasgow-speed talk, so I helped them out until they could determine, without the need for Language-line, that the man 'winae gonnae be deed any minnit', as we say.

Like I’ve often said, some jobs can catch you out and my assumption that the 50 year-old man who had collapsed in the West End, and who was being tended by police, would probably be yet another drunk proved entirely wrong when I saw his face as I got on scene. He was very pale and very unwell looking.

His wife and friends were with him and almost as soon as I started to check him out, he became vacant and floppy. He looked, in fact, like he was about to go into cardiac arrest. I got the defib out and the ECG. He was put on oxygen and pads were placed onto his chest as he lay back onto the pavement, looking for all the world (and most were passing by) that he was about to go on me. He didn’t, luckily, and after what seemed a long time of calming his wife and friends, the ambulance arrived.

His ECG confirmed the two previous strips that I’d already taken – he was having an anterior MI, so we got him to the appropriate hospital rapidly.

He was still conscious and aware when we arrived and he was taken up to the cardiac unit. His wife and friends were understandably anxious but I persuaded them that everything was fine and that he was in good hands.

The funniest gay couple on Earth next I think; one of them ‘Rocky’ (don’t worry they won’t mind) was flat on the ground, very drunk, with a police officer standing over him. The other, at about 3 feet tall, was leaning against the wall, telling me that his boyfriend was ‘too drunk’. This young man had the squeakiest voice I’ve heard for a long time and used it to state the obvious - repeatedly.

The Booze Bus was coming down the road on its way to another call but I got it flagged down and the crew were happy to take ‘Rocky’ and his squeaky-voiced boyfriend to hospital.

On Shaftesbury Avenue a group of friends protected an 18 year-old girl who’d allegedly become unconscious for ten minutes after a guy she’d rejected threw a glow stick at her, striking her eye and causing minor damage to it. She denied drinking much and her friends were very vociferous about this but I can’t believe a plastic tube in the eye will knock you out a good while after the incident. Still, it needed to be reported to the police, so that’s what happened.

A crew arrived to take her to hospital and her mates, the males especially, got a bit noisy and shuffly about not being able to travel with her. I carried her sister and a friend in the car; that way there was no more arguing. Honestly!

The worst type of drunk is the intelligent type, in my opinion. A 24 year-old newly qualified doctor (yes doctor), was carried towards the car by her friends and a large gentleman who told me where to park when I arrived. Like I needed directions to the kerb.

Her friend was a lawyer. I know that because she told me when she decided she’d obstruct my care of her staggering mate. She argued that the very drunken doc had been ‘spiked’ but they all say that and generally, it’s the drink that did it... not a date-rape drug. She was so determined to come with her friend that she woman-handled me as I put her mate in the car and then tried to get in practically by force. I have a bruise in my armpit where her stupid thick thumb gripped me as if I was a piece of flotsam and she was a drowning important person.

I got the police to calm her down and keep her out of my way as her friend projectile vomited in the back of the car and contaminated all my equipment. A large puddle of thick vomit occupied the seat next to her and it was left to me to clean it all up - I needed to use the 'scrape and scoop' technique.

I had no choice but to take this lady to hospital in the car because there was nothing available. One of her other friends approached me and asked if she could come with her. 'Are you sober and sensible?' I asked politely. She came along but as soon as I started to drive, she too swore at me, telling me to 'shut the f**k up' and ordering me to turn the radio music down (which I could barely hear), because it was 'inappropriate'. This happened while I was driving them to A&E. She repeatedly told me of how much trouble I was in and the extent of the complaint she would file against me. Even in the hospital A&E department she told the nurse I was a 'knob'.

I honestly believe they thought that their ‘breeding’ and education meant they had free reign to speak to me as though I were nothing more than dog waste on their shoes. It was a disgusting display of abuse and I, for one, am not prepared to just sit there and take it. On the way in, I warned her that if she spoke to me again like that she’d be out of the car. That, I think, is fair enough and I was certainly prepared to stop and turf her out.

I heard later that the abuse continued inside the hospital and that her other friends, who all turned up, had to be stopped from mobbing their way into the A&E department. Vulgarities were thrown around because the nurses and doctors wouldn't do a drugs test on her! Remember, these were all newly-qualified professional individuals. I had to call the police to protect myself and my patient from these people, all of whom will wake up with headaches and no remorse whatsoever about their behaviour because I am NHS and they are... oh, fill it in yourselves.

I think I am getting very tired of this job now to be honest.

An RTC that I thought would lift me from Hell to the clinical stuff I was actually trained for was a disappointment – not that I wish to underestimate the pain and emotional stress a broken foot would cause after a taxi had run over it – but because it required no skill on my part and the crew arrived pretty quickly, so there was virtually no proper examination of the patient, a 20 year-old woman.

While I was waiting for the crew to land, two men starting laying into a car driver in the middle of the road. He was in his car and the blokes were punching his face through his open windows. The police were on scene with the broken foot girl, so all of this was taking place in full view of the law. Needless to say they were both nicked after a brief chase – they could hardly deny it after all.

I was asked by a MOP to help out a man who was having trouble walking. ‘He’s really wasted’, the young Somali man told me. So, I went to see and what I saw was a drunken man, that’s all. The young man who’d asked me to help insisted that he needed to go to hospital but he didn’t even know him – he was just a fellow Somali.

To prove a point, after a long time waiting for an ambulance that really wasn’t needed, and an entertaining period of Glaswegian banter from the concerned young Somali man (he was brought up in Glasgow and born in Amsterdam but still thought he was Somalian - he was Dutch, wasn't he?), I called the whole thing off. The drunken man had unzipped his fly as I was talking to his girlfriend on his mobile phone (not that I knew her you understand). He’d pulled his penis out and I knew what was about to happen. I’d already suffered the messy vomit from Doctor Drunk; I wasn’t having any of this nonsense, so I put the phone down and took my leave, calling in a cancellation while he drunkenly, brazenly and shamelessly (which all amounts to the same thing) peed like a horse in full view of everyone passing on Leicester Square.

The shift ended with a drunken male who was sleeping it off on a grass verge. Four PCSO’s guarded him until I arrived and there was little I could do but look at him and do a few obs until the ambulance arrived to take him away. See? I have my uses.

Be safe.

Tuesday, 13 July 2010

Crazy Postie

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

Stats: 1 Renal pain; 1 ?CVA; 1 hypoglycaemic; 1 ? # big toe.

Not the best start to the shift when I was sent to a possible kidney stone / UTI at a sorting office. The employee was in the toilet with his shirt off for some reason. His trousers were loose at his waist and he wore no underwear. This very bizarre person was ranting and puffing as he dealt with his 8/10 pain and he stomped around being extremely unhelpful; something I understood with pain, so I can forgive it.

I couldn’t get through to Control and this is happening more and more now that I am just another resource among many; it meant I couldn’t find out if an ambulance was available for this patient because I could predict his behaviour if I took him in the car and I wasn’t sure I wanted to risk it. After a long period of trying I gave up and decided he’d get morphine and a drive to hospital – I couldn’t just sit there and ignore his pain and need for treatment.

When I got to hospital he kicked off – shouting, swearing and lashing out at me when I tried to guide him safely into A&E. ‘You are attacking me and I don’t like being grabbed’, he said. This guy was bigger than me and I did no more than lift him up from the ground when he threw himself down and attempt to steer him towards the A&E entrance. He was having none of it and his aggression escalated until finally I shepherded him in to the department, where he continued to raise his voice and stamp around like a child.

When the dust settled he apologised for his behaviour and, as I said, I held no grudge because pain can create a monster from the gentlest person – not that I knew him enough one way or the other. When I got back to the car I discovered that my finger had been torn open, either during the attempt to lift him up or when he swung at me. Now I have a plaster and a war wound.

On the pier, at the Embankment, a 73 year-old man collapsed after losing the use of one leg. The staff took good care of him and called an ambulance and I was sent to investigate. I asked for a vehicle to be sent because, regardless of the low category and minor details given, he was not a well man. He was diaphoretic, confused at times and had a positive FAST with left sided weakness – the side he’d lost the use of his leg on. He was nauseous but not vomiting.

His two young grandchildren were with him and he was more concerned about their welfare than his own, so I made sure they were chaperoned and when the crew arrived we got him on board and comfortable – that included giving him Metoclopramide to ease the nausea and take the strain off his ICP (retching will increase it and if he’s bleeding this will cause more damage). Oxygen was delivered and he was blued in to a Hyper Acute Stroke Unit (HASU) for definitive treatment. His grand-kids remained calm throughout.

The consultant at a dental hospital decided that twenty five spoonfuls of glucose in water would bring a hypoglycaemic diabetic, who’s BM was 3.4, back to the land of normal blood sugar. It did a wee bit more than that - it elevated his serum glucose to 19.1 and climbing. Usually, when IV glucose is given by us, we put no more than 50ml into the bloodstream and wait for a result, cautiously evading the possibility of raising blood sugar too quickly and inducing hyperglycaemia. With some care a hypo can be turned into a happy 4.0 and then a sandwich or biscuit will keep it there.

The two dental nurses who were given the dosage (followed by a sandwich) were embarrassed by the new BM reading, which shot up in less than an hour and I advised that, should there be a next time, they may want to consider just five spoons in a glass of water (25ml) - and patience.

We can’t do much for a possible broken toe, so Mr 35 year-old broken big toe from Colombia got his poorly Hallux wrapped to splint and a thumbs up for luck. He wanted to get home after falling down a few steps at a language school and damaging his foot digit. The staff at wherever he is learning the language packed him off to the train station first aid room because they didn’t have a first aider, either on duty at the time or in existence... my money’s on the latter.

His toe was probably only bruised; I’ve seen a lot worse being sent into the waiting room after an x-ray and advice to ‘keep it elevated and take paracetamol’. The same advice I gave him in fact.

Be safe.

Monday, 12 July 2010

Park life

Here's a letter I received, demanding 35p which was still outstanding from a cleared bill. Above it is the cost of postage in order to get this 'threat of further action' to me. Dumb arses.

Day shift: Seven calls; three by ambulance; two left at scene; two by car.

Stats: 1 RTC with # foot; 1 alcoholic (withdrawing); 1 fall; 1 chest pain that never was; 1 ? aortic aneurysm; 1 faint; 1 near-choking.

It’s cooling down a bit thankfully and the shift started early with a call to Piccadilly for a cyclist who claimed he was hit by a bus which went over his foot. He was sitting in the middle of the road and two MOPs had stopped to help him but his feet, one of which was broken, were sticking out into the lane and vehicles were passing very close by.

The bus driver stated the man had fallen in front of him and that he hadn’t made contact with his body. Neither man – the cyclist and the bus driver – spoke good English so it was difficult to ascertain exactly what had happened. There were no witnesses, although I’m willing to bet that at least a dozen motorists saw the incident but chose to continue driving to work or wherever.

The man complained of spinal pain, so as soon as the crew arrived, he was collared and boarded. He also complained of abdominal pain but there were no marks on him. His foot had a nasty lump on it and the skin had been torn away from the heel, so something had certainly gripped and dragged his foot along the ground. Something had gone over it too, thus the fracture. He had one flip-flop near him but the other one; the one that would have shown damage and blood staining consistent with a bus going over it, was nowhere to be seen – so the 'smoking gun' was missing - very strange.

It’s too early in the day for alcoholic calls but the emergency services are here at the beck and call of those who are shaking and nervy and have ‘chest pain’ as the result of alcohol withdrawal; those who live in parks and who call almost every day for the same reason – like the Polish man whose fellow drinkers dialled 999 and asked for an ambulance because he was having a ‘heart attack’. Calls like this only annoy me because I think of all the elderly, fragile and needy people who are unwell and who have never abused themselves to the point of suicide – individuals with a tax-paying right to the service we provide and who will wait while we collect and deliver yet another quick turn-around NHS special on behalf of the righteous.

The man wasn't having a heart attack or any other kind of attack - unless you count the kind of attack your body initiates when you don't drink alcohol when it needs it.

At a bookshop a 62 year-old lady stumbled and fell down a few steps; she wasn’t hurt but the staff wanted her checked out just in case. The lady had a history of double Laminectomy but had experienced no back trouble since the ‘90s – she had full function and no pain, so it was a simple case of getting her cleared fully in the ambulance and then dropping her off around the corner where she was heading anyway.

When a call comes in for a 14 year-old ‘with chest pain’ outside a popular tourist location, you can pretty much bet your savings that you’ll be risking your life on the road to get to a kid with issues – not all of the time but 99.9% of the time. So, we run on the eight-minute timer because someone has said ‘yes’ to the chest pain lead, even though the probability is low but there is no concern about the much higher probability of risk to myself or a member of the public while I am driving ‘safely but efficiently’ (that means do the damned eight minutes) to the job.

Of course, I win my bet and its absolute nonsense. The kid is face down on the ground having some kind of mood swing while his mother and siblings from abroad look on. Common sense had left the location as an ambulance and myself got on scene, all blue lights and fuss, just so he could walk off again after a quick check, smiling and none the worse for wear. Send them all a bill in the post I say!

Aortic aneurysms are serious and have the potential to cause sudden death – so sudden in fact, that the patient can die in mid-sentence. Surprisingly this call, to a 76 year-old man with a previous history of aneurysm, was given an Amber, so no need to rush then. If he’d been drunk, I would have been ordered in on a Red and eight minutes, as the prescription demands but with this I could trundle down there and take almost twenty minutes about it. I didn’t, however – I got to him in eight minutes, as would have any of my colleagues because we all understand the nature of this particular beast.

He wasn’t pale and he didn’t seem in too much pain but his finger pressed gently down on the specific point from which the pain emanated ‘sharply’ every now and again. The location, over his Liver, gives rise to suspicion and when the crew arrived he was taken to the ambulance fairly quickly.

In the basement of a very hot restaurant (no air con) a 32 year-old Dubai lady fainted. This was her second fainting and it happens when she starts her period. Her husband was with her but soon enough the entire family appeared – even dad came out of nowhere to show deep concern. At the same time a General Broadcast on the radio announced a chest pain collapse that urgently required an ambulance, so I decided this lady could go in the car.

Her husband travelled with her and the family was already in the packed waiting area when I put her there. No seats were available, so I got her a wheelchair to sit in and she’d have to endure up to four hours in the heat of the hospital now. I think this obviously rich family will probably be disappointed with the service – they must be used to something quite different. Still... it’s free.

The last (and late) job was for a 3 year-old who ‘swallowed’ a coin. In fact, he didn’t swallow it – the little silver thing was still stuck between his trachea and oesophagus; when I arrived on scene there was no ambulance because the call had been downgraded as the boy was ‘breathing normally’. That’s all fine but if the coin is still in situ there is a high risk of damage or choking if it is not removed as soon and as safely as possible. That’s why I took him in the car, with mum, on lights into Paediatric A&E.

The boy’s father – a doctor – saved his son’s life when he saw him turning purple in the face. A quick thump on the back and he was breathing but the coin had dislodged and gone into the oesophagus, where it could be seen pressing the edge. This is a high-risk scenario and no amount of 'he's breathing normally' should have been allowed to change the nature of it - he hadn't been breathing normally at all for a short while; he's only three - so why not just treat him as an emergency? Why not let the alcoholic park dwellers sleep it off while we get to these genuine problems quickly? It's time the Government gave us all a break and let us do our jobs.
Be safe.

Friday, 9 July 2010


The foot belongs to a female police officer (not sure if I can say WPC anymore) who broke her toe and was waiting in A&E for the good news. Her x-ray shows the damage. She will now and forever be known as 'hopalong' - by me anyway. Oh, and yes, permission was granted to publish these.

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

Stats: 2 unwell adults; 1 faint; 1 no trace.

No student with me today.

The morning started off fairly quietly then a call for a blind man who was vomiting and suffering a headache took me to a caller I knew; a man I’d conveyed to hospital in the car a few years ago. He gets lonely and calls us so that he can go somewhere noisy; the last time I helped him I think he was complaining of the same problems, although he didn’t look ill then and he certainly didn’t this time.

A crew was sent, even though I could have taken him in the car, so I left it with them.

Surrounded by the clutter and mess of Parliament Square where protestors camp as a testament to their right to protest, whilst ignoring the rights of others to enjoy the right to move around without bumping into a tent, a 53 year-old Orange County (California don’t you know) lady fainted whilst on a bicycle tour with her family. She was recovering when I got there but, given that her BP was very low and her pulse almost undetectable initially, I thought it best to wait for the crew and get an ECG done in private, rather than out in the open.

I chatted to her family while this was being done and got to know a bit about them (‘cos I’m nosey) and I also spoke to the cycle tour guy. He told me about the tours and allowed me to mess about with the plastic squeaking toys that were fixed to the handlebars, serving as warning ‘bells’.

Emotional problems often manifest as physical illness, whether real or imagined, and we get to collect the resulting ailments and take them to hospital where no treatment is available. So, the 47 year-old man with ‘DIB’ who had no trouble breathing but cried a lot, was taken in the car when his temperature was found to be slightly high (possibly a mild viral infection). He’d called 999 ‘for advice’ but we don’t do that and so an ambulance (well, the car) was sent.

All the way to hospital in the car he lay flat across the back seat, even with the seatbelt on. He was highly emotional about something and, try as I might, I could not get him to tell me what. Strangely, when we arrived at hospital and I handed him over to a nurse, he developed chest pain. He was destined for the waiting area prior to that; he ended up in a cubicle.

I bumped into the female PC with the broken toe while completing the handover of this patient and we managed to concoct a more realistic drama over the origin of her injury – a foiled bank robbery. She tackled three armed robbers single-handedly and one of the guns dropped onto her boot, breaking her toe. There you go, much more heroic than running into a wall I think.

When MOPS call ambulances because a street-sleeping person is using the street to sleep during the day, they tend to panic and think that person may be dead – or almost dead. Rarely, they are correct and we get there to find that CPR would benefit them. Mostly they are wrong and we run around the area and find nobody dead. Sometimes we find somebody asleep and that’s what we expect to find. The situation is made more confusing when the MOPs making such calls refuse to stick around and point out the offending human article. You’d think if they were distressed enough to assume it was an emergency they’d do one of a three things: 1. Try waking the person up or checking to see if they are breathing; 2. Stay on scene and shout at that person from a distance if scared; 3. Just wait on scene.

I ended that little excursion with unnecessary paperwork and a few irate drivers who didn’t agree with the way I blocked their path when driving to the ‘emergency’. I’d feel the same if I was driving home but I don't swear at anyone because of it.

Be safe.

Thursday, 8 July 2010

Wobbly knees and cyclists

Day shift: Five calls; two by car; one declined; one treated on scene; one by ambulance.

Stats: 1 fall; 1 RTC taxi vs cyclist; 1 faint; 1 abdo pain; 1 dislocated knee.

Green calls are usually (but not always) irrelevant to the emergency ambulance service but we continue to run on them and find, in most cases, that the person could have walked/hopped/hobbled/skipped or crawled to a Minor Injuries Unit, or A&E, or their GP or reality. It seems we are blanketed as a society and must call ambulances, regardless of the actual need for one, simply because they are available.

So call number one was a typical green; a 45 year-old Spanish cleaner fell into a lift and bumped her hip, so inevitably it hurt a bit. She then sat down and let it stiffen for half an hour until we arrived. Of course it was painful now and she found it difficult to walk but not to weight-bear. After a few steps she was using it well enough to walk down to the car, get in the back and enjoy a ride to hospital... and the rest of the day off.

Cyclists don’t have it easy in London and many of them have collisions, some of which result in death or serious injury, Luckily, most of them are minor in nature, as was the case with the 25 year-old man who went over his handlebars after hitting the back of a taxi when it slowed in front of him. He admitted he was to blame because he hadn’t been watching the traffic and he may have been travelling a little too fast but when it came to the real crunch – the cost of repairing the dent in the cab – the police had to come and sort it out. Cyclists generally do not have insurance; at least they are not required to have it, like other road vehicles, so when they cause damage there is little or no compensation for those affected.

The taxi driver will have to foot the bill for a panel beating job to make good the tail of his cab – that seems unfair but the cyclist denied causing the small ding to the bodywork. We left it with the police officer to sort out; rather him than me.

Fainting at underground stations is very common; fainting anywhere when you are of a certain age needs medical checking. For example, if you are 76 and have had a faint before, then it is time for an ECG and a thorough check over at hospital. So, this lady, who collapsed at an underground station, got an ambulance. She was recovering well enough but her BP wasn’t impressive and she still seemed a little pale. The crew was with us in less than ten minutes and off she went, husband in tow.

Abdominal pain is one of those things that causes controversy when commented on by people like me in any negative way – for example, when I think there is nothing there but a hallucination of pain. Of course true abdominal pain can be a real emergency but most of the stuff we get is not and never will be. Some of it, like the 14 year-old girl who claimed 10/10 pain in the presence of her over-protective family, and then told me the needle in her skin (for morphine) was more excruciating, is nonsense.

I offered her all sorts of pain relief but she was less inclined when told her the more potent analgesia came via needle. In fact, she reported a drop in her pain immediately after I withdrew the cannula and abandoned the attempt due to her constant squirming. The smallest needle in the world was being used, trust me – a prick from a sewing needle is worse.

In the end, she walked, accompanied by five members of her family, to the car and we took her to hospital. This wasn’t her first visit for such complaints – none of the other problems were ever diagnosed.

A 32 year-old large lady with hypermobility syndrome and who has a long history of knee dislocations called us out to help her when she collapsed off the toilet and her patella popped out. She’d already pushed it back into place when we got there but was still unable to put her weight on it. This was because the knee cap was still a little too high in the leg, so I slid it down into its proper anatomical position and she was instantly cured – no pain and straight back onto the leg.

She didn’t need to go to hospital and we left her with the necessary paperwork and a bandage around the knee to support it.

Our day ended off the road when the car decided not to bother starting while we were on standby on Trafalgar Square – a more public place for a flat battery I couldn’t imagine. Two police officers roped in a white van man from TNT delivery services to ‘jump start’ the car (thank you WVM and TNT) and then the RAC rolled onto the Square and checked the battery, pronouncing it dead and replacing it. The RAC man then told us the battery wasn’t charging as it should and thus the shift ended with me driving back on only the energy inside the battery. Still, it’s warming up again weather-wise...

Be safe.

Wednesday, 7 July 2010


Day shift: Two calls; one left at home; one by ambulance.

Stats: 1 dementia pt; 1 emotional person.

Five years after the terrorism of 7/7, Londoners remembered those who lost their lives and those who suffered otherwise. Again, a low-key kind of memoriam was going to be carried out, mostly away from the areas that were actually affected. The plaque in Tavistock Square is gathering floral tributes but only a few will stand before it or say words like they used to.

After a long, quiet start, the first call of the day took us (my student is with me again for the next few shifts) to the south on a mercy mission that had absolutely nothing to do with accidents or emergencies. It was a social issue that could have been sorted out by the family.

The 90 year-old woman who called saying she was ‘frightened’ had dementia and didn’t know where she lived. She’d been left on her own but her family lived above her. It took me a while to get in contact with her daughter and she explained that the lady wasn’t normally left alone for too long. That was just as well because she needed to be on her home oxygen but wasn’t; she’d unplugged herself.

We left her in the care of her grandson and advised caution with her in the future because she is very likely to wander off and get herself into trouble.

A last minute call (ironic considering how slow it’s been all day) took us to a man in his fifties who had collapsed in his car. His son was with him and had reported his father ‘fainting’ but he hadn’t – he was just upset about a phone call he’d received. We left this to the crew when they arrived. Again, this type of call has no bearing whatsoever on us as an emergency service.

Be safe.

Thursday, 1 July 2010

Life changes

Night shift: Five calls; two assisted-only; one treated on scene; two by ambulance

Stats: 1 MS pt; 1 ? Fit; 1 ?# Leg; 1 panic attack; 1 taxi fare dodger.

The car is no longer controlled by human beings with medical knowledge and therefore the ability to intelligently send the appropriate response to a call. Now, as before in the bad old days, a computer is tasking me on every call, regardless of how suitable (or not) it may be. This didn’t work before and I doubt it will work again but I am only a minion, like the others who want to do the best job in the safest way, so what I think is irrelevant.

The first call was simply an assist-only; the 53 year-old woman with Multiple Sclerosis had travelled on the baking hot tube to get to an evening out with friends but failed to complete her mission when her legs, predictably, stopped working. Two police officers helped her up to the station booking hall and I arranged for an ambulance crew (SJA) to bring a chair so that we could get her to street level and into a taxi for the homeward journey. Her friend arrived to travel with her and all was good – her night was ruined but she is struggling to come to terms with her new deteriorating condition; she won’t be travelling on the underground again and probably never will. She told me herself that it was a ‘hard learned lesson’.

Up in Leicester Square, the vampire lovers gathered for the premiere showing of that vamp movie and one of them, a 30 year-old female had a seizure on the ground that she’d spent more than 24 hours sitting/lying and crouching on as she and the other fans waited for a glimpse of their favourite stars. She had no history of epilepsy but she had definitely fitted and was post ictal. She’d lost bladder control and was slowly coming round but still very confused.

A private paramedic team was on scene helping out when I arrived and an ambulance arrived within ten minutes to take her away. By that time, she was more lucid and co-operative. It’s possible the heat had got to her – swelling her brain and causing her seizure. It’s also possible she is epileptic now.

I was sent back to the same location for a 31 year-old man who jumped from the back of a lorry and possibly broke his leg. His mates told me they heard the crack as the bone split when he landed. Sometimes ligaments tearing will sound like that, so there was the possibility of a bad sprain, although when I palpated the swollen mass that was his ankle, I thought I could detect crepitus. He had good pulses and colour in the foot, so apart from the pain, this was a simple job.

I asked for an ambulance and got one thirty minutes later – by that time I had given him entonox and morphine and put his injured leg into a ‘blanket splint’ which looked comfortable but was no match for a proper rigid box splint or vacuum splint, neither of which I carry on the car.

The ambulance had got lost around the area because the Square was blocked off and full of people so I went to help the driver get in but the vehicle wouldn’t start and it took a good few turns of the key before it behaved itself; by that time the audience at the local pub who’d been watching, cheered their approval. Then we nearly crashed through the film premier as crowds swamped us on the drive into the Square. Eventually we got to where we needed to be and the poor guy, who by now had been lying there for an hour, was taken to hospital.

Outside a pub, a 19 year-old man was having a major panic attack in front of his girlfriend and other people who were milling about smoking. He was kind of hyperventilating but not the real kind because he was perfectly able to speak in unbroken, unhurried sentences as he flapped his hands and complained about the ‘tingly’ feeling he had.

I know some of you feel I am a bit harsh on the panic attack afflicted but I don’t mean to be... I suppose it could happen to me and then I’d be told, but come on, there’s panic attack and there’s mostly doing it for show.

He was treated on scene (30 minutes of talking, checking and re-checking) and left in the care of his girlfriend. Paper was left with him and he got advice – the usual stuff.

A complete waste of time next as I motored on a Red2 and found police with a 22 year-old Filipino woman who had refused to pay a taxi fare. She was feigning unconsciousness and I woke her up immediately with some medical persuasion. She didn’t like it and spat out abuse in broken English.

The taxi driver told me he'd been hailed by her and she’d pleaded with him to take her home. She was drunk and the driver, who has a daughter the same age, felt duty bound to take her. When she refused to pay the fare and became abusive with him, he drove her to a police station and the cops came out to deal with it. That’s when she ‘passed out’.

After a few minutes and another wake up pinch from me, she crawled out of the cab and was sent on her way but then, as I was chatting to the officers, there was a screech from around the corner. She’d fallen on her face. She was uninjured and as soon as we arrived to help her she started up with the abuse again. She really was a nasty piece of work and I think I can safely say whoever she lives with must be getting a lot of tender loving care from her. She didn’t get an ambulance; she was sent away to find herself another taxi. The poor cabbie that she ripped off got nothing for his trip.

A lull followed and I got a break for a few hours. I made my way into Leicester Square in the lightening hours and watched as dancing teenagers gave end-of-shift cops verbal abuse and drug addicts scooted around looking for change and a quick fix. Once the police officers had dealt with the nuisance, one of them asked me to look at a man they’d just woken up. They thought he might be too drunk to stay there but, after chatting to him I realised he was just very tired. The 28 year-old man had travelled from Luxembourg yesterday and spent the night on the streets. He had nowhere to go, no food and one set of clothes; the set he was wearing. He stank of stale everything and he looked like he’d given up. He told me he’d left home – left everything, so I guess he’s had some kind of domestic problem.

He looked intelligent enough to work out what a risk he was taking and he acknowledged this when I told him how dangerous London could be but I had a problem; he couldn’t be left there and he had no need of hospital. The police couldn’t take him anywhere and so we seemed stuck.

I drove him to the nearest hostel and left him outside. I told him that the residents would be out soon, gathering as they did every morning for their breakfast, provided by a charity group who visit the Strand. I advised him to ask for help because he was surely going to need it.

Be safe.