Inconveniences

Ten emergency calls. Three assisted at scene, one gone before arrival, one treated at scene, one false alarm and four ambulances required.

A frantic night. We were short of vehicles. Not crews, vehicles. There were five crews at station when I arrived and only one ambulance between them. Too many are off the road for repairs or are short of equipment, or something else is wrong with them. I was one of only two FRU's running so there was going to be a lot of slack to pick up before my colleagues were able to assist.

My first call came in before I had drawn breath for my VDI. I was running to a pregnant female who had fainted in the street, at least that's what the call description read. When I turned up (along with the only ambulance available), the 'pregnant' female turned out to be a fat drunken woman from Scotland. Nothing warms my heart more than a fellow Scot proudly showing the colours on English turf.

She needed nothing more than a prod in the right direction - that's the opposite direction to us - and off she stumbled, groaning all the way. I think she liked me; she gave me a gummy grin before she left.

So, a waste of all the resources available for a so-obviously not pregnant (or sober) woman. Some of these calls are generated by the public just so that they can have an eyesore removed from their doorsteps. There was a pub across the road and the locals probably didn't want her spoiling their evening drink, so a call for an ambulance is very convenient. I remember going to a call for a 'dead man in the street' just to remove a sleeping drug addict from the sight of the snooty lady who had called us out. She didn't like the fact that he chose to slump across from her window. She didn't like to have her view spoiled by another, less well-orf, less informed and less clean human being.

My next call was for a diabetic, possibly hypo, in a shop in NW1. I found him alert and fully recovered. He had eaten something to sort himself out and the call had been made by panicking shop staff who thought he was going to die on the floor. Again that would be terribly inconvenient, so reach for the phone and dial 999. The guy's blood glucose had dropped a little and he had become confused, that's all. He hadn't demonstrated any desire to keel over and snuff it but I guess the judgement of the panick-stricken few is somewhat skewed.

As soon as I completed my paperwork I was off to Islington for a 35 year-old male who was fitting in a pub. When I got on scene, he was recovering on the floor. He is a known epileptic and normally his condition is quite well controlled but he had been drinking and not eaten very much, thus asking for trouble. He was still post ictal when the crew arrived to assist but he was able to stand up and walk for us. On the way out, he decided to finish his pint, so we stood at the door with our mouths open in disbelief. He wasn't willing to give up the alcohol he had paid for just because of a little seizure. We could wait.

One of the pub staff came out to walk her dog while I was preparing to do my paperwork for the epileptic pint-finisher. He was a lovely little Jack Russell puppy and he sank his excited teeth into my gloves as he bounced and rolled his way back and forth on the pavement. I thought he might wet himself if he doesn't calm down, so I let him be and got on with my job.

I was half way back to my own area when I got dragged back up to Islington for a call to a 4 year-old boy with a head injury on a bus. This one sounded serious, so I did a quick 360 and headed back up the road.

The child was unhurt. He had no head injury and had simply been bumped into by a man who was getting off the bus when the driver hit the brakes a little too hard. The adult lost his balance and collided with the little boy as his mother stood him up to leave. He was sitting in his buggy and I spoke to his mother about the incident. I remarked that he didn't have any injuries and that taking him to hospital would be pointless. The boy's little head nodded sagely as I spoke. His mother told me that he was two years old in fact and I was shocked to notice how in tune he was with what I was saying, so I directed my conversation at him.

He was an incredibly clever young man for his age and he described, in some detail, the reasons why he might want to see his doctor whilst acknowledging my sensible explanation about a trip to hospital being a waste of time and likely to upset him more, let alone the unnecessary use of precious resources. I was so taken with him (as were the two police officers who showed up) that I stuck around for a while just to chat to him. He was very entertaining.

After completing my forms for the mother I said my goodbyes and left the bus. I did have one last thing to advise before I went though. I suggested he might want to use the buggy less and his legs more if he didn't want to end up overweight and unfit. He seemed to understand. I noticed his mother walked him off the bus after that.

I found myself in a grotty estate after my pleasant encounter with the boy. I was looking up at a block of flats that may, or may not have been the one I was looking for. There was no name plate and it was covered in scaffolding and nets. I asked a teenage girl who was walking through the vestibule area if I had the right place and she blanked me completely. It was a simple, courteous question but I got nothing from this rude moron. She did turn around when I shouted "thank you for that" sarcastically. She noted my annoyance and said "Yeah, it is" to answer my original question. Life would be so much easier if we all went back to real parenting.

Anyway, I got into the lift and it opened and closed with the sound effects from a horror movie. I'd rather have the smell of urine than the gothic creaking and groaning that emanated from this tin box I was getting into. I got to the relevant flat and spent thirty of your tax-paying minutes calming a hyperventilating, panic-stricken 44 year-old female who is 'sensitive to stress'. I told the crew I would handle this one myself and set about re-programming her breathing with a long chat about life and the Universe. I bored her into submission and she was cured when I left. Oh and no oxygen used for that one. I played it by ear.

I got back out of the lift from Hell and thought I might need to wear a long black cloak and fangs for this job soon.

Next up, another hyperventilating female but this time I lost her and the crew. The address was completely wrong and the ambulance (there were a few more on duty now) showed up just as I was searching the area for the hostel in question. The crew had no better luck than me but they weaved their way down the street and I followed. However, when I got to where they had landed I found them gone - already with the patient, I presumed. This was tricky. They were a Tech crew and if the call was not as given I would have to rely on one of them to come out and get me if things were serious and I was needed, either that or I could search for them, which I did without any luck. So I waited behind the ambulance like a lemon in the car.

Luckily the call was exactly as given and the crew appeared with a young girl and her mate, both looking healthy and in good spirits, so I left the scene and got on with it.

Once or twice I've had to search for a bus that just isn't there. A call for an unconscious female on a bus had me driving up and down Waterloo Bridge and the Aldwych, scanning for something big, red and with the same number on it that I had on my screen. Unconscious people on buses tend to be drunk and fast asleep - bus drivers will not touch them to wake them up, they'll shout a couple of times or throw things from a distance and then call us. We are the removal service for buses. We need to start charging a fee for our professional services methinks.

Control eventually tells me that the 'unconscious' person has alighted then decided to get back on the same bus to go home. An ambulance arrived as I received this information. The crew were just as pleased to hear the news as I was.

Someone put a hi-vis jacket and hard hat on one of the Gormley statues standing on Waterloo Bridge. I didn't get a chance to photograph it but I took one 'au naturelle' for you. I can't wait until summer kicks in to see what these poor defenceless statues get done to them (I'm sure various forms of fancy dress are in the pipeline).

I got a sniff of coffee at my home station then went to another estate to help a 70 year-old diabetic recover from his hypoglycaemic confusion. He was sitting in his flat, surrounded by his concerned family, smacking his lips and staring at whatever took his fancy. His BM was 3.1, which isn't critical but its low. He wouldn't take anything orally and had a strong grip, which he demonstrated every time I tried to coax him to eat.

I injected glucagon and waited a few minutes. He ate some glucose gel after that and became a little more lucid as time went by. The crew arrived but their role was going to be supervisory; he wouldn't need to go to hospital.

His family made him some sandwiches and by the time I left his BM had risen to normal - he was thanking us and tucking into some life-saving bread. The crew stuck around to ensure he was 100% recovered.

I got a break after that job and spent an hour or so replenishing my own sugar supplies. My next call was for a 22 year-old, unconscious in his cell at a police station. These calls are rarely as given and this one was no exception. The police officers had tried to wake him up as he lay sparked out on the filthy cell floor but had no luck getting any response. I pinched his shoulder muscle hard and he wriggled away from me, opening his eyes just enough to size me up. I did the same again and again until the police officers, the crew (who had just arrived) and the Forensic Medical Examiner in charge were convinced that my theory "he is sleeping it off" held water.

Just as I was putting the lights out in my head for the shift I was given a call that I was sure would keep me busy well past home time; a Red1 for an 'overdose, needle in arm, not moving'. It sounded like a classic heroin overdose - they die so fast the needle they have just injected themselves with is still in position. I was sure this was going to be a messy resus.

I arrived to find that the people in charge of the place had locked themselves out. They were banging on the front door and screaming for someone to let them in. I thought the call was going to descend into farce. I knew the location - I had been there a few times before. It's a hostel for the lost and unlikely to recover individuals of society. It houses drug addicts, alcoholics and ex-cons who inhabit its squalid rooms in singles or pairs, depending on whether they own a dog or not. This guy owned a dog.

He was sitting outside his room and he wasn't dead. Neither did he have a needle in his arm. He told me that he had injected himself with heroin (he thought) and that he had also taken a load of prescription pills of various colour and type. I checked him thoroughly and thought it was unlikely he had taken anything in fact. He had taped a note to his door reading 'by the time you read this I will be dead - take care of my dog for me'. Poignant but pointless, I thought.

The man was generally unpleasant and his cry for help was just one of many he had tried in the past. Without counselling, advice or structured support he has nowhere to go but down. On the other hand, not to dismiss the good people out there who do offer these services, maybe he just doesn't care. Drugs do that to people - they lose the self-interest they need to improve their lot.

I popped my head around his door to say hello to his dog. On the floor, wrapped in a blanket was a well-mannered and frightened mongrel. I offered him my apologies before I left the scene. I think he understood although I could still see deep misery in his big brown eyes.

I gave my handover to the crew and the police, decided I needed to do nothing more here and drove south to my car, my civvie fleece and the long, horrible journey home.

Be safe.

Sugar and spice

Six emergency calls. One treated at scene, one conveyed and four taken by ambulance.

My shift started out with an introduction to a feisty ninety seven year-old Irish woman who was suffering from heart failure. Despite her DIB, swollen ankles and obvious discomfort (“I’ve been better” she says when I ask how she feels), she is still able to rail against the inevitability of her condition.

I climbed into the back of the ambulance after carrying out my initial obs at her bedside and prepared a diuretic for her. This would ease her breathing and during the treatment she made a request, after complaining about the needle in her arm:

“Can I have some brandy in that?”

If it was legal and I had any, she would have been more than welcome to it.

I completed the paperwork on my aged Irish comedienne, left the scene and got about a mile down the road before I was asked to turn around, go back and assist with a crew who were working on a suspended alcoholic.

He was only 45 years-old and had been found in bed at his hostel, vomiting blood as a result of a massive internal bleed (gastro-intestinal). This brought about a cardiac arrest in front of the key worker who was trying to help him. When I arrived the crew were busily working on him on the floor. There was a good deal of blood around and his airway was a mess. The paramedic was attempting to intubate and I could see it wasn’t an easy job for him but he got the tube in and secured it while I set about gaining IV access and preparing the drugs that would be needed. I have to say that there are some jobs you just look at once and decide there is little or no hope. This was one of those jobs.

We frantically ventilated, compressed and drugged him until another crew arrived to help with the removal to hospital. I had been on scene for about ten minutes and there was absolutely no change in the man’s condition. The ECG showed persistent PEA and the prognosis was poor.

We prepared to move him down stairs (he was a large man and the stairwell, as usual, was very narrow) and tidied up our equipment. I asked the key worker and another member of staff to help carry the bags as we moved the resus effort from upstairs to downstairs and then into the ambulance. The first crew on scene conveyed the man to hospital and I took the key worker in the car so that he could pass on next-of-kin details to the hospital staff.

In the Resus room, work continued and many more people got involved but it was called by the doctor in charge and the man was pronounced dead forty minutes after he arrested.

I went back to the flat with the key worker because I had forgotten one of my bags and the place looked like it had been raided, the detritus of our effort was everywhere and there was plenty of evidence of recent death; blood on the floor, a crimson pillow on the bed and a little trail of the stuff leading from the flat to the outside world. In the bathroom, the man had prepared his shaving kit for the next day, not knowing that he would not live to see it. I always find those poignant little things very sad.

The doctor at the hospital told me that he was glad we had been working on him first because he would have found the job too messy and very difficult to manage. He praised our team, which is rare.

After a short interlude to replenish my drugs and equipment, have my much needed coffee and complete my VDI (I had no chance when I came on duty) I wandered back to my home station north of the river. I had just set foot in it when I got a call for a diabetic who was possibly hypo at his workplace. It was late at night but a lot of people work through the night in London, especially printers and graphic designers, who find the relative quiet and lack of traffic a reasonable alternative to the rat race. In fact, I have been called to quite a few diabetic problems in workplaces at odd times of night.

When I arrived and entered the premises I could see four men; one who was working at his computer, one who was thrashing around, looking ever so pale and sweaty and two who were holding him down and trying to reason with him. I'm not sure if the guy at the computer even knew there was a commotion two feet behind him.

After establishing whether or not the thrashing man was capable of aggression or had been violent, I checked his BM – 1.4 – not good at all. I set about preparing Glucagon; he was far too active to tolerate an oxygen mask and his friends had already tried to make him eat but he had almost bitten their fingers off. I decided to use Glucagon to start the ball rolling, raise his sugar levels and then give him something sweet. It usually works very well.

He struggled against me but I gave him the injection with the help of his restraining friends and stepped back to wait for a result. Glucagon takes between ten and twenty minutes to have an effect but within a few minutes I was able to give him oral glucose. He nearly bit through my finger and caught my glove whilst chomping down on the plastic tube but he ate almost all of it (the glucose, not my glove).

After a further five minutes he began to relax and recognise his surroundings. He took a little more glucose and I asked his friend to pop out and get him a sandwich or crisps so that he had the necessary ‘slow burn’ carbohydrate to finish the job. All the time I worked alone. No ambulance was available at first and I cancelled it after the first ten minutes when I realised progress was being made. Recovered diabetics usually refuse hospital treatment (and don’t need it anyway) after an uncomplicated hypo.

I rechecked his blood glucose level and it was now 4.3 – much better. He was making sense, although still unsteady on his feet and he told me that he probably doubled up on his insulin injections today, which would explain his condition. It’s likely, I suggested, that he was already becoming hypo when he injected his first dose of insulin. This would have made him even more hypo and the confusion would have led him to believe that he needed more insulin. Or he had simply forgotten.

He was fully recovered and quite embarrassed when I left him half an hour later. I like hypo calls; I can do something about them almost immediately and in almost 100% of these jobs we gain a certain satisfaction about having ‘saved’ someone. It’s one of the easiest life-saving procedures we carry out and it is extremely common.

Back up to my home station for a break then out to a 52 year-old man with urine retention. He was in a lot of pain when I arrived and he apologised for calling an ambulance because he knew that this was not really an emergency. He was already being treated for a UTI and his retention amounted to nothing more than difficulty peeing. However, I recognised his discomfort and he wasn’t play-acting, so I thought a trip up to the hospital (ironically where he works in the finance department) wouldn’t do any harm.

This call had come in as an ‘aggressive diabetic’ but the only aggression I perceived was aimed at CAMIDOC who had failed the man. He had tried calling them for help but the line was ringing out, so he had no recourse but to dial 999. It’s a familiar story.

I conveyed him and his wife in the car after cancelling the ambulance (there weren’t any available anyway). Once I handed him over I reminded him that he should consider releasing some of the money upstairs for the nurses and doctors who were currently putting him out of his misery. I think he smiled but it may have been a painful grimace.

A few hours sailed by – well, they never sail when I hit a quiet patch, they crawl on arthritic limbs – and I was sent to King’s Cross station for a female with chest pain. I searched and searched but couldn’t find her. Nobody waved at me and the crew, who turned up a few minutes after I did, had the same problem. Just before the ambulance pulled up, a man wandered over with half his finger hanging off and blood dripping onto the pavement.

“Can you put something on this, or shall I get it dealt with at hospital?” he said drunkenly

I glanced at his partially-amputated digit and decided chest pain over-rode it. I told him I had another patient to deal with but he was persistent...and bleeding near my boots. So, as I scanned the area for a possibly dying heart-attack patient, I bound his exuding extremity in a dressing and pointed out the hospital (at the end of the road), instructing him to go to A&E and get his finger stitched back on.

The distraction meant that the crew were somewhat confused and bemused. They left me to deal with Mr. Finger whilst they searched inside the station. It occurred to me that I hadn’t even bothered to ask the man how he had come about ripping his limb off in the first place.

I joined my colleagues in the station but they were looking lost. It was quiet; rush hour was still an hour away, so it should have been easy to spot a lady in agony. Nothing.

Then, as we all made our way to the exit, a woman, who had been sitting on a bench watching the entire spectacle, raised her hand. The ambulance attendant asked her if she had called us. Yes she had. It didn’t take much experience to determine the lack of crisis here. She was a homeless Romanian woman (and there will be many more soon). She just wanted a bed for the night and knew how to play the system. I think there is a special school somewhere in which the great British system is explained in detail. All the tricks of the trade are taught in this school but it is strictly out of bounds for tax payers. Sorry.

I was across the bridge and less than a mile from freedom (going home) when I was turned around by the wicked FRED and sent to an assault in the opposite direction. I sped off, arrived and was flagged down by an Italian windmill. His friends had been gathered in the street (the tourists come out very early to catch their buses and trains home) when a drunk stranger happened by and punched one of them in the head for no reason. The young man’s head was bleeding a little and there was a gash in the back of it, so the ambulance crew took him off to hospital.

It’s nice to know that, whatever time of day it is, you can rely on someone to represent this great capital city of ours. Welcome to London chaps.

Be safe.

Fuel for the fire

Seven emergency calls, all requiring an ambulance.

A short, sharp kind of night shift – the City’s bodies are moving in familiar circles, preparing themselves for the drunken binge that we know as summer (and they call fun). Already there has been a tragic death as a result of alcohol-fuelled stupidity.

My first call was to a '42 year-old man with chest pain on roof'. I thought I was going cherry-picking again. The man was a construction worker who was up on the roof of a department store when he began to feel unwell. He had abdominal pains, not chest pains and they seemed to be more muscular than cardiac in origin but, with caution on our side, the attending crew and I checked him over thoroughly and he was taken to hospital where they would get to the bottom of it.

Then on to a 77 year-old man who had collapsed in the street. When I arrived there was a little crowd of people around him, including his wife who was quite anxious. He had been walking home with his spouse when he suddenly stumbled and fell, hitting his head on the way down on a wall. He had been drinking earlier on but not much, I was told. He had no obvious head injury but he did not look well at all and, as I proceeded with my obs, he stopped responding and closed his eyes. I couldn’t get him to open them.

He was still breathing but it was shallow and his pulse felt weak and thready. This man had either suffered a stroke or he had simply fallen and the bang to his head had complicated things. He was a little cyanosed but, at that age, it’s difficult to determine whether that is because of an acute event or age-old hypoxia. I presumed nothing and put him on oxygen while I waited for the ambulance to pull up.

When the paramedic from the ambulance approached for a hand-over I asked for the trolley bed – it felt rude not to start off with a “hello, this is...” statement but the man still wasn’t responding properly and he had to be taken off the street and into the vehicle as quickly as possible. When he was inside and an ECG started, he began to respond and was soon back to normal(ish); his skin colour was still bad and he was diaphoretic and limp.

His ECG was abnormal and he was taken to hospital on blue lights.

A baby with a high temperature was my next patient. He was lying on the floor, surrounded by his concerned family, only one of whom could speak English, so I was left to communicate my requests and reassurances in broken language, facial expressions and gestures – it makes for much harder work when treating someone. As it turned out, the baby had a history of high temperatures and was simply restless with it; his temperature was 38.1c but his grandmother had made him shiver with cold by flannelling him for too long with a cold, wet towel.

He went to hospital, where they will probably dole out more Calpol and Nurofen because without evidence of an underlying, treatable cause, there’s not much else they can do.

I was being bounced back and forth into the EC1 area of London all night for some reason (probably a shortage of ambulances and personnel). Most of my calls were in this region and my next job, a 70 year-old Chinese man who was suffering DIB, was no exception. I found him sitting on his bed in a small, cramped flat, shared by a few other Chinese residents. His young friend told me he had flown in from Hong Kong recently and was doing martial arts, as he always did every day, when he suddenly collapsed with breathing difficulties. He also described a sharp pain in his chest.

When I examined him, he was restless, was having great difficulty in breathing, with very low sats of 82% and was off-colour and sweaty. He had a history of high blood pressure but had no problems with it normally. The martial arts exercises were gentle, I was told – no more than Chi in nature.

The crew had arrived with me on this call but were a minute or so behind me while they gathered the stuff they needed from the ambulance. I had gone ahead to start the assessment. All the basic signs and symptoms were there for a PE and the additional information about the recent long-haul flight and his propensity for high blood pressure lent weight to that diagnosis. There was always the possibility of infection too, so I asked questions relating to recent illnesses and contact with birds and fowl. I discovered he had been treating himself for a recent chest infection, so that couldn’t be ruled out either.

During the shift, I saw this man in Resus and asked the doctor about him. He was being investigated for a PE and his condition was poor, although he is likely to recover after treatment. He went up to ITU later in the night.

I responded to a Red3 for a ‘female with pain in her lower body’ before I thought of questioning it. Normally I would radio in and asked what in the nature of the call made it such an emergency. This time I was on scene and chatting to the newly arrived crew before it dawned on me that it was a mistake. The crew had received this call as a Green, which means it is not an emergency and that makes sense. For some reason I got it as a Red, so the result was an over-resourced call and an unnecessary risk to me and other road users during my run to it on blue lights and sirens. Control apologised for the error, so I won’t harp on about it.

After a quick five minutes at the station I was heading out to a local club to deal with an 18 year-old female who had collapsed after possibly having her drink spiked. More likely, however, she was drunk.

When I arrived I was ushered into the back of the club, where she lay on a couch, out cold. Her friends were with her and they stood back and looked on as I tried to persuade the drunken girl to respond in some way. She had been out in the sun all day drinking and then come to the club with her mates to drink some more. Initially, she was completely unresponsive but after a few minutes and during my obs, she moved and reacted a little.

By the time the crew arrived and she was hauled into the chair like a big sleeping rag-doll, she was becoming a little more aware. In the ambulance she began to nod and shake her head in answer to questions, which is just as well because I had opened my bag and was about to put her up on fluids.

The police had been called because there had been a suspicion of drink spiking or drug use but the crew and I confirmed that she was simply too drunk to function, so they left knowing that they had much less paperwork to do for this one.

The girl later recovered in hospital. Her mother and aunt appeared and sat with her for a few hours the prepared to take her home later on. I spoke to them and her aunt turned to the girl and said, “don’t worry, think of it as life experience to learn from”.

Or you could just not drink so much.

My last call of the night was for a male with a head injury. He had allegedly been accosted by someone outside his flat when he was dropped off by taxi in the early hours. There was a good size pool of blood in the street, just where he would have been dropped off and little splashes led the way into his apartment complex. If he had been hit over the head, then it had happened immediately after he stepped out of the vehicle, which didn’t make sense unless the taxi driver did it (I imagined).

The crew were on scene with me and I stuck around to assist if need be. He appeared at the door of the elevator after his sister had shown us in. His mother was with him and together we all went back down to the ambulance.

His head was matted in blood and he had a long, fairly deep gash in the back of it. He had no memory of what had happened. He just remembered waking up with his head covered in blood. So whoever hit him had left him in the street – he could have died for all they cared.

His money and personal items had been stolen.

This wasn’t an alcohol-fuelled crime, as with the story I highlighted earlier but it was certainly assisted by alcohol, given that the young man had been out drinking and probably looked less aware and alert to his attacker(s), so therefore an easier mark. His loss of memory is probably a direct result of the blow to his head but it could also be an exacerbation of alcohol.

It’s unlikely the police will find who did this to him but he was lucky. If he hadn’t regained consciousness he would have been lying in the street, bleeding from his wound, for a long time before anyone found him.

Be safe.

Not sure where this is going...

I saw this billboard when I was last up in sunny Paisley (Scotland). If it's what I think it is then I expect a LOT of blokes have already dialled the number to assist!

Cherry picking

Eight emergency calls, one conveyed, one cancelled, one sent packing and five requiring an ambulance.

The day starts with a RTC involving a car and a motorcycle. He (the motorcyclist) is clipped by her (the car driver) who is now sitting on a wall crying about it. It’s her first RTC in six years of driving and she is (understandably) upset, although no amount of reassurance on my part, or that of the crew in attendance, will persuade her that everything is okay. The motorcyclist turns out to be as hard as nails and is let off by God without a scratch. He bounced down the road, thus paying the penalty for trying to weave in front of the car during a right hand turn.

Then another tearful emergency call to a walk-in centre for a 46 year-old male who has chest pain. When I arrived I could see the cause of his chest pain – he was hyperventilating...and crying... a lot. His girlfriend is with him and she seems anxious but a little embarrassed too. I never found out why the man was crying so much and I only managed to resolve his state of panic by removing the paper bag given to him by the nurse and replacing it with oxygen, which did the trick. Please don’t write in about this, I explained the concept in an earlier post :-)

The crew arrived and removed him to hospital and I removed myself from the area...only to be called right back to the same walk-in centre. This time for a 22 year-old who was having an asthma attack. She must have walked in just after I left.

She was on a nebuliser when I arrived for the second time (the patients in the waiting room were getting worried I think) and her condition was improving. A recent chest infection had exacerbated her asthma (common enough) and her inhaler was next to useless as a result. Once she was stable and her breathing had improved sufficiently, I conveyed her and her friend to hospital myself; no need for an ambulance in this instance.

I was tempted to get a cup of coffee after that job and was well on my way when I received a call for a male, age unknown, apparently fitting and unconscious in the street. The street in question is in the location of some of my regular drug-abusing time wasters and so I thought it might be one of them causing a stir in the public domain again. I got on scene to find a known alcoholic sleeping on the pavement, as he always does. A young lad was waving at me frantically as if his world was about to end. I sounded the siren right next to my sleeping friend and he woke up. Wouldn’t it be great if all our calls were that easy?

I chatted to him about sleeping in areas where nervous members of the public are likely to call us and sent him on his way to another ‘bed’ – he wasn’t happy (they never are) and he threatened to thump the next person who called an ambulance when he was trying to sleep off his extra strong lager. How dare they?

Anyway, the concerned citizen saw what was going on and joined his other worried companions for a game of football in the road. It’s possible the drunken sleeper was simply in their way, or they needed another one to make goal posts.

By the time the crew turned up, Mr. Sleepy was stumbling away. I discussed the job with my colleagues on the ambulance and they promised to let me know if a ‘decent’ job came up. They were true to their words.

The crew pulled up alongside me and the attendant said that a ‘fall onto roof’ had just come in and would I like to join them. They were a Technician crew, so I could legitimately request to assist them. I called it in and I got permission to follow on.

The ridiculous road works slowed us down quite badly and it took us all of seven minutes to crawl two minutes up the road. We pulled in at a building site and were set upon by pale-faced construction workers. One of their mates had fallen from a height onto the roof of the six storey building and had sustained some sort of head injury. We had been asked to report for HEMS but thought we should wait until we had assessed the man’s condition first.

We climbed to the roof of the building and across the length of it, negotiating our way over some precarious areas of slate and glass to where the young man lay. He was about 22 years-old and was lying on his back in a v-shaped gulley near the edge of the building; any nearer the edge and he would have fallen straight down more than a hundred feet. He was conscious but there was blood coming from his mouth and he appeared to have an injury to his arm. On the basis of his injuries, the mechanism for other potential injuries and the complicated extrication we had ahead of us, my colleague called for LFB assistance while I confirmed our need for HEMS, just in case.

I began the assessment of the young man while equipment and personnel were brought to the scene. It was an extremely awkward place to conduct obs and treatment and standing on the angles of the roof made life hard on the legs after a few minutes.

The patient was stable and I cleaned his airway as best I could. He had fallen from a scaffolding board that he had erected between the main scaffolding structure and the roof itself, at a height of about twelve feet. He had tumbled onto the concrete ledge below and hit it face first, losing teeth and bits of his lips in the process, thus the blood coming from his mouth. He had also damaged his arm (probably broken his humerus) during the fall and was lying uncomfortably in the tight wedge created by the roof angles. He was in pain but he seemed neurologically and haemodynamically sound.

Once a few more colleagues had gathered, his neck was collared and I got on with IV access, anti-emetic, pain relief and fluids (KVO), with the help of a team leader and the EMT from the ambulance. The LFB arrived and raised their ‘cherry picker’ up the scaffold-enclosed front of the building to within a few feet of us, in preparation for the removal of the patient. There was no other way he could be brought down from the roof.

The HEMS Delta Alpha team arrived and were brought up using the cherry picker lift. Now we had quite a crowd gathered on the roof; the construction workers, who were helping out and ensuring our safety; a Duty Officer, a Team Leader, myself, two technicians, two doctors and two HEMS paramedics - quite a party.

I had been on the roof with the patient for almost an hour before we had him ready to go. He was now on a scoop stretcher and tied in securely (we hoped). I volunteered to go down with him on the cherry picker. This meant I had to hold on to the scoop all the way down to stop it from slipping or tilting over the edge, though I wasn’t sure what I was going to do if the thing actually did try to slip off. I was securely clipped in - the patient was not.

After a smooth descent to the ground and many sighs of relief, we got him into the ambulance and off to hospital. He was very lucky not to have been more seriously injured, especially where he had landed. Getting him out of there in less time than we did would have been unlikely, so time-critical injuries would have cost him – and us.

I was dusty and sweaty now and my equipment needed to be re-stocked, so I took the opportunity to take myself off the road until I was decent enough to serve the public again. I also got a cup of coffee out of the deal.

Then a 61 year-old in custody at a local police station required my attention for his chest pain. He was an angina sufferer but he didn’t look convincing at all. As with most of these ‘in custody’ calls, the reality is that the ‘patient’ is looking for a way out. This man seemed to acknowledge this but continued the charade when the ambulance crew arrived to take him to hospital.

I don’t mean to come across as uncaring but I don’t have much time for people who just can’t take their punishment if they have done something wrong – like shoplifters who feign chest pain / abdo pain / pregnancy and all sorts of things to get away from their predicament when caught. It makes no difference - they're still busted.

Of course, this man may have been experiencing a twinge of angina as a result of the stressful situation he was in but his acting was terrible and his face and body could not co-ordinate themselves properly for the ploy. Sorry, not convinced.

I was given a quick run up to Oxford Street for a 20 year-old who had fainted. The problem is, I was given a shop as the location and discovered that there were at least three of them on the same side of the street and Oxford Street is a long road. By the time I had worked my way through the traffic and sorted out one store from the other, the crew were on scene (after making the same mistake) and dealing.

My last call of the shift was for a 35 year-old male who was fitting in the street. When I got on scene I was waved down by the patient himself. He told me that he was fine and no longer required an ambulance. He explained that he was a diabetic and his blood sugar had run low as he was waiting for his meal at a restaurant (he had taken his insulin prior to ordering). His friends were with him and it was clear he was recovering but still wasn’t totally there yet.

I asked him if I could stick around and check his BM and he agreed. His BM was still low (2.3), so I suggested he ate something and I would wait with him until he recovered completely. I got the restaurant to send out some bread while he munched on a Mars bar, given to him by one of his friends.

The ambulance had been cancelled on this call and I was informed of this by Control as I pulled up, so there wasn’t going to be any further fuss made. I just wanted to ensure he was safe to carry on his day.

After ten minutes or so, the food brought his sugar levels up to near enough normal and that was that. He and his friends were off to the football match at Wembley – England vs Brazil. I offered my condolences to the losing team. :-)

Be safe.

Horse sense

Nine emergency calls. One refused and eight requiring an ambulance.

I think it’s quite clear what has happened to my role since the abolition of the Amber Car. Almost all of the calls I deal with will end with a patient being conveyed in an ambulance, sometimes unnecessarily. Those ‘walking wounded’ jobs haven’t disappeared; they are being dealt with by crews who are once again being asked to attend the most minor problems. Many of these crews will feel obliged to convey and many of these patients will insist.

My first call this morning was to a 78 year-old female with chest pain. A genuine job; she has a recent history of angina and certainly didn’t look well when I arrived. The crew were already attending to her and I assisted where I could by gaining IV access, just in case.

If, as seemed the case, her angina was unpredictable then it was best she went to hospital and had her condition checked – unstable angina is a potential killer.

Then off to a 30 year-old male complaining of back pain after lifting a heavy load. He was stuck in his delivery van when I arrived - he couldn’t move for the pain. A little entonox sorted him out though and he was loose enough by the time the crew arrived to be walked to the ambulance.

A 40-year-old who was fitting at a homeless shelter needed no help from me, or anyone else. The crew were on scene just ahead of me and were dealing with an alcoholic who had probably had a seizure as a result of his love affair with drink. He was lucid enough to be walked to the ambulance and I was not required.

Most of my colleagues will tell you how annoyed they get when they receive calls to GP surgeries for chest pain, only to find the poor patient sitting alone in reception, with no analgesia and no doctor in sight. To make matters worse, they are often ‘handed over’ to us by the receptionist. My 40 year-old patient walked himself to the front door when I got on scene. The receptionist trailed behind him and got him to return to his seat. He wouldn’t have walked off if he had been taken care of I thought.

The man was certainly not well. He had central chest pain and was very pale and diaphoretic. He had acute shortness of breath and couldn’t complete sentences; all ominous. I had completed my obs when the crew arrived. He was wheeled out to the ambulance where an ECG would determine whether he was in immediate danger or not.

I had a bit of a rest back on station after that job, then I took a long trip out of area to attend to the needs of a pregnant 37 year-old with back pain. The pain was radiating through to the front of her body, so she told the 999 call taker she had chest pain (when asked) and that prompted an over-the-top emergency response.

When I questioned her about the pain it became clear that it originated in her lower back, the sacrum in fact. I don’t dispute that a pregnant woman with chronic back pain should be checked out but episodes of back pain are common in pregnancy, as the lady should know - it was her second child. She walked out with the crew and was taken to hospital. I expect she returned home, with back pain, later that day.

Just as my day was rolling out routinely, I received a call to a 25 year-old female who was having a fit at an office in Central London. I raced round to the address, climbed a few flights of stairs and reached my patient. She was older than 25; she was in her mid to late forties. Her colleagues were around her and she was lying on the floor looking bewildered. It looked like a classic post ictal state, so she could well have had a seizure.

I asked what happened and was told that she had suddenly dropped to the floor, fitted for a few minutes and then recovered to her present confused state. I looked at her and she didn’t look well. She was very pale and sweaty and extremely agitated. I calmed her as best I could and began my obs. I had just completed them when she began to fit again. She tensed and twisted. Her eyes rolled up and she clenched her teeth, her body posturing in an outward stretch (decerebrate). This didn’t look like epilepsy to me at all and it reminded me of the little boy I had rushed in to hospital with minutes to spare a month or so ago.

This lady had no medical history for epilepsy or any other related problems. She was not diabetic and had never had a fit before. In her most lucid state she had confirmed all of this to me. One of her colleagues mentioned that she had been acting strangely a few days earlier and that she didn’t seem herself - restless was the word he used.

I maintained her airway, gave her oxygen and gained IV access while I had the chance. I had considered diazepam but I decided I wasn’t looking at epilepsy here. Her BM was normal - in fact all her signs were normal, apart from her breathing and pulse, which were understandably, a little fast. As her fit stopped and she began to return I spoke her name a few times - this made her jump and cry out in fear. She was in another place, that was for sure.

When the crew arrived she had begun to recover from this episode and I was assessing her level of consciousness. I told them what had happened and gave them my opinion. I felt we were dealing with a subarachnoid event (SAH). I was even more suspicious of this when, in response to being asked if she had any pain, she told us she had a headache and located it by pointing to the back of her head, just above the spine.

Although she was now becoming more alert and her GCS had improved to 15 by the time she got to the ambulance, she still looked very unwell. Her colour had not returned to normal and she looked as if she was going to deteriorate. She was taken to hospital very quickly.

I was still analysing that job when I was asked to go to the Euston area for a ‘male, collapsed in street’. This usually means drunk or drugged.

When I arrived I found that my patient was being guarded by two mounted police officers. They hadn’t actually dismounted to check him, they thought it best to surround him instead. He was lying on the pavement, obviously breathing but very deeply unaware of what was going on around him. The horses had drawn the attention of a few on-lookers, so the young man on the pavement had an audience.

I shook him and pulled him upright. He was completely out of it and wouldn’t even open his eyes. There was no smell of alcohol and it was clear he had been using something. I tried a few tests (BM, etc) but he wasn’t having any of it. He was responsive enough to clench his fists and push me away if I attempted to try anything, so I gave up and let him be until back up arrived.
Meanwhile, I chatted to the officers on horseback and patted their horses. Apparently police horses like the smell of medical gloves. I kept an eye on my charge of course but I wasn’t going to continue harassing him in case he decided to become awake and unfriendly.

The crew arrived a few minutes later and the game started again. He still played dead, so we had a look in his bag and found evidence of drug use, probably crack cocaine. No use in beating about the bush here, he had the ‘paraphernalia’ and he was out of his head. The obs we managed to get were normal, so we knew he wasn’t a medical emergency but he still wouldn’t wake up, so he was taken to hospital quickly to be assessed and perhaps returned to the land of the living.

I went with the crew and watched as he returned himself to this land while the doctor and nurses fussed over him. They soon got bored and left him sitting in his bed, looking like a waste of space.

Off to the other end of town for a female who had fainted. I couldn’t find the address, even though I was driving up and down the correct street. Road works and traffic make for a difficult life when you are working solo. After a long search I discovered the address was on an upper level of the street, which was strangely split in the middle so that a separate road existed with the same name. The delay meant that a wiser crew had been on scene a few minutes when I arrived, so I wasn’t required.

My shift ended with a call to a 23 year-old female who had been in an altercation with a taxi as she crossed the road. Entirely her own fault (as she admitted to me); she had walked into the road without looking and the taxi had interrupted her, throwing her onto the bonnet and chucking her, in a most un-lady-like manner, onto the road. Luckily for her the speed at which she was hit was low and the only bits of her body that had suffered any damage were her chin, which was cut and her hip, which was painful.

I expected I would have to convey this lady myself but she didn’t want to go to hospital. Actually, she didn’t need to, she had minor injuries and the mechanisms involved were not substantial. She was literally knocked over at 10 miles an hour. After a quick inspection of her chin and hip I got her to sign my magic form (she got the three refusals option of course) and off I jolly well went.

When I got back to my base station, I learned that the suspected SAH patient had fitted again in hospital. She was scanned and a large bleed was discovered. She was referred to a specialist neurological centre but her condition is unlikely to improve.

Be safe.

Shocking

Seven emergency calls. One assist-only, six required an ambulance.

This strange call took a colleague of mine onto the roof of a bus.

The rain is keeping people out of trouble and it's still relatively quiet for me. My ambulance colleagues are as busy as ever, I should point out - they have to deal with non-emergency transfers and assist-only calls on top of their emergency duties and although I am on a go-slow as a result of being on the FRU, I'm glad not to be doing that stuff to be honest.

The day started out with a couple of 'not required' calls: a faint at a hotel followed by another faint in Oxford street that was changed to choking (for some bizarre reason). In the first instance I didn't see the patient because the crew were on scene and dealing. The faint/choking job turned out to be nothing more than a simple collapse in the street. The woman was chatting to the crew when I arrived (as did the motorcycle solo). It was a lot of fuss for nothing really.

A 35 year-old male with chest pain had to wait longer than he should have because the address given was wrong and it sent me and the ambulance down the opposite end of the road in which the actual address existed. After two or three minutes of crawling along on blue lights looking for the building in question we got an update and raced off to the top of the road. Luckily, he wasn't having a cardiac event, he was panicking and hyperventilating. Again, I didn't have to do anything for him - the crew dealt with it and took him off to hospital.

Remember I said that my colleagues on the ambulances had assist-only jobs that I was glad I didn't have to do at the moment? I was asked to assist a gentleman who had become stuck in his bath. I was only around the corner and a crew were on their way and since this type of call is a non-emergency, they could be fifteen or twenty minutes away, so could I please go there and help him? I wondered what I was going to do with the man. I was told he weighed around 23 stone and was stuck fast. He had no injuries apparently, so I assumed my role would be to keep him company until the cavalry arrived.

When I got on scene a woman greeted me and introduced me to her husband in the bath. He was indeed a large man and he was indeed stuck fast. I had a go at de-wedging him but the bath was slippery and my back was beginning to groan at the attempt. I tried turning him and swinging his legs over the edge; the idea was to 'lever' him out but his weight kept him pinned to the wall and I was no match for it. So I gave up, waited for the crew and chatted at length to him.

His wife was in the front room doing the crossword and every now and then she would shout through an offer of a cup of tea. I declined the offer several times as I spoke to the man.

It turns out he was a career soldier - he was in his seventies now but had seen action in various parts of the world, including South Africa. He was a very interesting guy to talk to and although my military experience is minuscule in comparison, he was a fellow RAMC medic, so we had something in common. He had been a Regimental Sergeant Major and had obviously loved what he did. His wife had been with him throughout his army life and now she had to contend with his bath-bound problems. I discovered that he had been rescued before.

By the time the crew arrived I had been chatting with him for half an hour and had declined the offer of many cups of tea. We hatched a plan to lift him by degrees up on to a pile of cushions at his back, then swing him straight out but that failed because we couldn't get him to lift his own weight. So we went back to my plan, which was to swing his legs over the edge and lever him out. It worked this time - there were three of us pulling on him. He came out of the bath, albeit clumsily, popped his large feet onto the floor and waddled into the bedroom where his wife demanded he cover himself up immediately.

I said my goodbyes and left the crew to settle him back into his former enamel-free life. I walked to the car and thought about how interesting it was to have met him - maybe having more time with patients isn't a bad thing for solos. Maybe we should get one job a week like that just to keep ourselves in touch with people.

After a rest and my official break I was sent to a '13 year-old female, fainted'. I arrived at an iconic London tourist attraction to find a young French girl lying on the floor of the gift shop. She was surrounded by teachers and her school group. They had come over for a day visit from France and she had complained of being home-sick, apparently (her teacher told me) she hadn't wanted to come in the first place. She certainly didn't look happy to see me. She wasn't prepared to be friendly at all.

"Comment allez vous?" I asked in my best school French

Nothing.

Oh well I thought as she stared through me, teenagers with angst are the same all over the world. I explained this to the crew when they arrived - colleagues from my home station. They weren't impressed either. She was taken to the ambulance and then to hospital for no reason other than to find somewhere away from her friends where she could moan about her life.

Interestingly, I noticed that teachers from France behave the same as in the UK when faced with a moody, melodramatic child - they roll their eyes to heaven and regret the day they decided to join the profession.

Then on to a diabetic who had collapsed in the street. She had a BM of 2.1 and the crew, who had arrived on scene a minute before me, got to work on correcting the problem. As I assisted them, a man came up to me and complained that the hotel she had been staying in didn't have a first aider to help when she collapsed. I assumed that she had been staying in the hotel he was talking about but what he expected me to do about it, I didn't know. He was right though - it is a legal requirement for places like hotels to have a first aider on duty at all times. Then there's real life.

Finally, a man whose internal defibrillator was going off randomly, giving him shocks. This will happen if the device is faulty or it is actually stopping him from going into cardiac arrest. Either way, it was a unique and thoroughly interesting call for me. When I arrived he was lying on his bed, looking terrified. The first shock had prompted him to call 999 and while he was on the phone he got another one. He told me that it had happened before and that the battery was faulty and had to be replaced. He warned me not to touch him in case I got a shock when it went off again but I had obs to do and I was sure the energy wouldn't be enough to cause me harm. However, I did think about how tricky moving him was going to be when the crew arrived - he was a big man and must have weighed twenty stone or more. There were eight flights of stairs to go down (no lift) and if the device went off as we were lifting him in the chair he would jump and probably unbalance us, resulting in a fall and injuries to himself and (probably) us.

I called Control and asked them to relay the information I had so that the crew had a heads-up. I warned them about the man's weight, the stairs and lack of lift - oh and the unpredictable state of his defibrillator.

When the crew arrived, the paramedic (who had not been told about the man's size) took one look at him and requested another crew. We got one FRU paramedic. Still, with the four of us, we were able to get him down the stairs but it took a lot of careful balancing - we had a huge patient, a dodgy electrical device and two hands each on one of four corners of a little chair. We squeezed and angled our way down the world's narrowest stairwell. Luckily, during our descent, his maniac defibrillator behaved itself.

The man's ECG was all over the place and we weren't sure if we were looking at bogus electrical activity from the defib/pacemaker or he was having a cardiac event. He didn't have any chest pain and he had no other adverse signs or symptoms - except fear of the next shock.

He was taken to the specialist heart hospital just in case. The crew felt it was better safe than sorry, which is fair enough. I went ahead of them to give them a smooth journey and he was admitted - the consultant wasn't sure either apparently.

Be safe.