Friday, 29 July 2011

The unsung

A good shift is one where the calls are steady and not too bad, and where the teams around you are good to work with. Generally speaking, all the frontline crews I meet are great but the A&E Support crews, who don’t really get a look in, are among some of the stars. I’ve met a few and have been very impressed by their knowledge, skills and the application of their work. I worked this shift with an A&E Support crew shadowing me on calls... well not deliberately, they just happened to be the nearest and most appropriate for the type of call I was getting.

It started with a jog down to Waterloo station, where another crew was already on scene, dealing with a separate incident from mine. I was going to a ‘leg injury’. A motorcycle paramedic was already there, and a screen had been erected around the poor 58 year-old lady who’d fallen and hurt herself. I was invited to take a look at the injury and was quite startled to see a fractured knee cap and a dislocated lower leg. The patella was broken through its centre; one half had slid up the leg and the other half remained more or less in place. It was a gruesome looking injury but the lady was in no pain at all. Amazingly, this injury had occurred as the result of a spectacular slip... on a train ticket that was lying on the polished floor of the station concourse!

The MRU paramedic had to leave us because yet another call had come in from the station – an epileptic was having a fit not far from where we were. Three emergency calls had been taken from the same area in a 20 minute period.

So, I chatted to the woman, offered her entonox for when we moved her leg, which was inevitable, and waited for the third ambulance to come and take her away.

It wasn’t long before my colleagues showed up and we carefully straightened the leg. She took no pain relief because she told us she felt no pain. I could imagine someone younger and fitter screaming in agony at this point, but not this lady. When the leg straightened out, it automatically slid back into place and we were left with an aligned limb (it had been at an angle from the knee down prior to this) and a Patella with a single, unmistakable ridge across the middle.

We took her on board the ambulance and she still felt okay, apart from the odd twinge.  She still didn’t need any pain relief and I was very impressed by her attitude, but I knew that her knee would never be the same again and she’d probably have other associated problems to deal with throughout her life now.

From one station to another; this time a tube station a few miles away from my last call. A 37 year-old man was sitting on a bench, feeling dizzy every time he got up to walk. He’d been like this all night and had tried to resolve it by eating fruit... who knows? Anyway, on his way to work, he became too dizzy to continue the journey, so here he was, waiting for me.

He had a history of hypertension, so it’s possible there’s a link. He wasn’t vomiting but he did feel nauseous, so when the ambulance arrived (an A&E Support crew) he was carefully trundled out on a chair. His ECG was normal-ish and his vital signs were good, so the crew took him to hospital and I traveled behind them in the car, just in case.

On the next call, for a 24 year-old man with back pain, I was sent to an office complex that was under renovation. The patient was the site carpenter but when I got on scene, I didn’t find him nailing bits of wood together, instead he was lying flat on a wallpaper pasting table. He was in agony.

The man had suffered a back injury years before but had been fine since. Now, all he did was sit down and his lower bank went. He told me the pain radiated down his leg on the same side. It was possible that he’d pulled a muscle, or there was nerve involvement. A disc may have given a little. Whatever it was, he had to come off that table.

I asked for, and received another A&E Support crew. I’d given the young man entonox and a dose of morphine, and his pain score had reduced. So, when the crew arrived, we got him to carefully move himself off the table. He wasn’t so unstable that he needed a spinal board, but he had to be handled with kid gloves because the smallest change in his position caused pain. By the time he’d started sitting down in the carry chair, he was complaining of nothing more than the dizziness expected after a long lie down on a table. That and the morphine, I expect.

The poor guy was worried sick about the long-term effect the injury would have on him, especially as he was self-employed and relied on work with no sick-pay benefits. He told me he had a new baby at home and it concerned him that he might not be able to make ends meet. I felt a lot of sympathy for him.

No patient contact with the next one but only because I went to the wrong hotel. In my defence, there are two hotels in the same little area, with the same name, apart from a minor sub-title. I’d stood in the lobby of the wrong place, ready to complain about being held up on an emergency call (an elderly woman was feeling very unwell), when the Manager informed me that they didn’t have the room number I asked for. He pointed across the road and said ‘But they do’.

So, I drove ten metres to get to the correct address and the crew showed up. I became redundant at that point, so I left them to it.

The same A&E Support crew came to assist with the next call of the day. It was for a 36 year-old man who worked in a hotel that is notorious for calling ambulances and then repeatedly calling back, with worsening symptoms that often don’t exist, just because they have been waiting. On this occasion, they’d called for a man with ‘abdominal pain’. That is not enough of an emergency to get an 8-minute response, so they had to wait. But, true to form, they called 999 again and added ‘difficulty in breathing’, which made the call go RED and I was asked to go and check it out.

I got there to find that the man had groin pain and had no trouble breathing at all... except for the obvious breathing change that accompanies groin pain.

One of his testicles was causing him discomfort and the sharp, burning pain was travelling up into his groin and lower abdomen. Although this is an unfortunate situation for any man, it still isn’t a life or death emergency, so I asked for an A&E Support crew, and I got the same call sign assigned to me that had helped me on the back pain call.

Once aboard the ambulance I asked the man to drop his trousers and let me see what the problem was. Unorthodox as this may seem to you, it is quite important to visualise a point of pain, so that obvious injury can be ruled out. It’s simply a question of whether or not you have the steel to do it. Obviously, with a female the rules for me change but visual examination is still crucial wherever possible. I was looking for evidence of torsion (twisting) of the testicle, a potentially ball-losing injury.

I had a quick look and I couldn’t see any evidence of unilateral enlargement. However, I was able to get the man to specify exactly where the pain originated on his testicle. He pointed to the bottom of it. He may have Epididymitis, I thought. He’d be going to hospital to have it checked out (excuse the obvious hotel-inspired pun) whatever the problem was. If he had torsion, it would have to be dealt with immediately.

He’d told us his pain was 10/10, but he jumped and cried out ‘Allah!’ (he is a Muslim), when his finger was pricked for a bit of blood. People who say they have more pain than someone giving birth, and then scream when they get a little jab with a one-million gauge needle really need to get their thresholds in perspective.
Once again, I left him to the crew to take away to hospital. He’d declined pain relief on the basis that more pain would be required in order for him to receive it. He was stable and in no immediate danger. So I wasn’t required any more. The crew, S and J, were happy to take over and transport him over as few bumps in the road as possible.

The end of the shift consisted of me sitting in the car on Traffy Square, thinking about all the years I’d been standing by on that spot, and the people I’d worked with... and the observers I’d shared my scenery with. A young film producer had arranged to meet with me so that she could chat about how we hand patients over at hospital. She’s making a short movie and it includes a scene where ambulance paramedics lose a patient. So, I was to tell her how best that could happen in hospital.

She got more than she bargained for because, just before she turned up (and I should add that I had ended my day’s duty and was heading home after the meeting), I was asked to check on an alcoholic who was lolling about on the pedestrian area, while tourist kids and their tourist teachers, passed by.

He was a Romanian man; quite young and very shabby, although his photo ID depicted someone who’d been brighter, cleaner and a lot more alert than this in a previous life. He was drunk and demanding an ambulance for stomach pains. Liver pain – that was his problem.

I had to put off my meeting while I dealt with him, so the producer stood by with the rest of the interested public, as I held on to him when he thrashed around and insisted on lying back down every time he was sat up. I had a Trafalgar Square security man with me – he was the one who’d asked me to help – so two of us were struggling at times to keep this guy under control. He wasn’t violent, but he slammed his head onto the ground repeatedly in an attempt to over-ride sanity. He wasn’t drunk enough to behave like that, he just wanted to.

I called in for an ambulance and lost communication with Control completely when my hand-held radio died (flat bat) and my car radio didn’t want to transmit any more. Up until that moment, both were working just fine.

Luckily, I got a message through to them via my own desk, CSD, and I was sent an A&E Support crew again. Not the same crew, a different one, but still very welcome.

After a bit of chatting and being ignored, we got him into the ambulance (but only after he feigned collapse and put my back out). He spent all of ten minutes in there, arguing with us about his condition, which we weren’t disputing at all. Then he declared that he needed to pee, and he stood to do so inside the ambulance. I’ve seen this happen many times.

He was told off in no uncertain terms by the crew, and he turned to leave. Even though we were giving him what he wanted – a lift to hospital – he still felt his need to urinate, right there and then, was much more important. He got out of the ambulance and headed towards the public toilets (we think).

And that was that. He’d refused help after all the drama he’d put us through. I asked the crew to leave so that they could get home on time, rather than wait for him to return, and I spent another ten minutes on the square, telling the producer how to lose a patient in fiction-land, whilst simultaneously giving the Romanian peeing drunk a second chance to get help if he needed it.

He obviously didn’t because he never returned.

Be safe.


LiBallerina said...

My god what a day for train stations eh?????

merinz said...

My youngest son lives in London, a long way from our New Zealand home. He travels into inner London every day to work through some of the train stations you sometimes mention.

It is a measure of comfort knowing that you guys are there doing your job so well should he ever find himself in need of assistance!

ivishcot said...

hi sorry to post something slightly unrelated (well, not completely...) I'm a film student in sheffield, currently writing a character who is a trainee paramedic. I've spoken to a recently qualified friend and got some background, but was wondering if you'd be to talk about your own experiences as a've got a skill for narrative and I'm looking to create a reasonably real portrait. email me if your game - Thanks

Mjolinir said...

OT - Panorama Mon 1st Aug on 'Problem Drinkers' - especially recreational-drunks-in-A&E-on-Fridays. Should be interesting?
[Should be on i-Player afterwards]

Anonymous said...

That is why I appreciate boredom. My perfect "Stag" is one where I am bored stiff! If I am not bored it means lots of things (usually bad) are going south and quite rapidly!