Out of it

Maybe this registration will be easier to understand ( a few of you got confused over the last one!)

Night shift: Five calls; one assisted-only and four by ambulance.

Stats: 1 Unconscious ? cause; 2 ETOH; 1 assault with facial injuries; 1 Arterial bleed.


The start of my four night run of shifts – I don’t enjoy these at all and this weekend was set to become one of the busiest of the year so far.


My first call was for a 25 year-old man who was unconscious and had a history of sudden collapse for no medical reason…none that had been found anyway. He’d recently undergone an operation to have a bone implant hearing aid fitted (BAHA) and, according to his wife and mother-in-law, his ‘episodes’ had started after that. He would develop a headache, go to bed and not wake up until he was taken to hospital by ambulance, where he would remain almost comatose for up to eight hours.

I found him lying on his side on his bed, up on the third floor of the house. The stairs were narrow and crowded and I knew as I climbed them that we were going to have real problems getting him down if he didn’t wake up.

The crew arrived after I’d carried out a few obs and I secured his airway with an OPA. Deep pain had no effect except to make him posture decorticately, which usually means there’s a major neurological problem (but that seemed unlikely given my baseline obs). His wife denied the possibility of drugs but his pupils were pinpoint and his breathing, which I’d heard long before I saw him, was very noisy – this is what prompted the 999 call.

We spent two hours on scene with this patient. He was given loads of Narcan, which initially had an effect (he had been taking pain killers which may or may not caused this problem). I couldn’t figure out a connection between his bouts of unconsciousness and the recent implant, unless he had a brain infection but he’d been to hospital and they’d found nothing wrong with him, so it was a real mystery.

Eventually, after one failed attempt to get him into a chair for the trip downstairs, we called in a Delta Alpha (doctor). The patient was a huge guy – 22 stone in weight and it would have been very dangerous to move him while he was potentially able to unbalance us, even with the three of us there. More people would have been impractical because of the narrow stairs and he seemed to deliberately slide off the chair when we attempted to strap him in, so there was no option but to put him to 'sleep' so that he was safe to move. The doctor gave him Ketamine and he instantly relaxed. Now he was manageable but we still had to carry his large frame down those stairs and it took a lot of sweat to achieve that without everyone being injured in the process.

His wife stood crying as we got him out of the house. She was fed up not knowing what the problem was with him and I sympathised but there was something strangely not right with this. He had moved himself off the chair earlier, I’m sure of it and so was the crew. He seemed to know what was going on and what was being said but he didn’t flinch when pain was applied (and that included a few needles going in).

He was rushed to hospital and I tagged along to see what would come of this but even in Resus he remained a conundrum. The doctor wasn’t convinced he was genuine and if he wasn’t, why was he doing it? Also, if he was acting, then I applaud him because he’s bloody good!

They have a new born baby and the problems started with him soon after its birth, so if Munchausen syndrome is a factor it needs to be investigated. Strange but true.


An upset 22 year-old female at a hostel was lying on the landing at the top of the stairs (why don’t they ever go down a flight or two for us?) when I arrived on my next call. She’d vomited because she’d been drinking and her mates fussed around her until she decided she didn’t need anyone but them. I cancelled the ambulance and left her to deal with her emotions.


Two young lads requested the company of a local prostitute in Soho. They paid their money up front and the lady of the night disappeared, leaving them sitting outside the flat where all the action was to take place. Two men approached them and argued with them as they tried to explain that they were waiting for service. The men reacted angrily to the intimation that their flat was a brothel and beat the boys up, smashing one of them in the face. It was, of course, a scam and they were naïve.

I showed up on this call and the lads hid away because their alleged assailants were still nearby. Then, after I’d almost called it a no-trace, they approached the car and begged me to switch off the lights and ‘not make a fuss’. They wanted the police and they got me. Nice to know that if there’s a potentially violent situation I could find myself right in the middle of it.

The ambulance crew was waiting around the corner because they knew more than I did and when they appeared, the two men were put on board and checked out. Then one of the crew went into a club to tend to a female who’d somehow cut the tip of her toe off while dancing (how on Earth do you do that?). I went down into the hot, noisy cellar to see if I could help and he was dressing the wound. Her blood soaked sock lay on the floor and a puddle of the stuff lay next to it. She was in good shape and smiled at the irony (although I think her alcohol intake helped ease the pain). No doubt, in the morning when she’s sober, she’ll laugh less when she realises she’s lost a pretty toe-tip.

Between them, the crew managed all three patients and this was made easier when the two prostitute-scam guys decided not to stick around.


An ‘unconscious’ man on a bus demanded to go to hospital instead of doing the decent thing and just going home. He was drunk and the crew felt duty-bound to take him where he wanted to go. NHS taxis at your service.


Finally, a 21 year-old woman cut her calf during a drunken stagger, ripping open an artery and squirting blood around for a while until someone decided an ambulance might be a good idea. The crew arrived ahead of me and I had a quick look before leaving them to get on with it. I’m no good as an observer - I keep wanting to do something useful...then I get in the way.

Be safe.

Scrap for knives

Early shift: Nine calls; all taken by ambulance (for a change).

Stats: 1 DIB; 4 Fitting; 1 Hyperventilation; 1 Miscarriage; I ETOH; 1 Chest pain.


So the police have been told to crackdown on the theft of metal around the UK. Drain covers and school roofs are being nicked for the price of the scrap, most of which is going abroad (China is starved of raw materials for its expansion). Its costing £300m annually and the nationwide raids are being made a priority. Ironically, we have a major knife crime problem, so maybe (and I don’t mean this to slur the police who have no choice) all that metal is being used to produce more deadly weapons. Maybe that’s why the Government thinks it’s a good idea to raise the bar on property theft rather than death by knife.


An 89 year-old woman with DIB gets my attention at the start of the day. She is wheezing and I can hear the fluid in her lungs as she tries to breathe. Her family are around her as I listen to her history of cardiac problems, type II diabetes and high blood pressure. She gets oxygen and is put on a nebuliser; her sats are very low and she needs to go to hospital quickly. The crew oblige and I run to the next call.


I’m not required for the 40 year-old man who’s fitting at work because a crew is on scene and the patient is recovering well.


I’m not sure about the next patient at all, however. She was mistaken for a man by a MOP in the park when she was seen to fit then become unconscious on a bench. I reach her and she is coming round.

‘What’s your name?’ I ask her.

‘What’s your name?’ she repeats as if it’s a test.

She’s clearly confused and is reluctant to be helped in any way, so getting a baseline is problematic, even with the police on scene. In fact, she becomes very annoyed when an Officer tries to take her bag to look for ID, accusing him of theft and threatening to report him to...the police.

The crew arrive a few minutes later and she is eventually taken away to hospital. She may have suffered a stroke or she may have had a fit – either way, I’m not sure 'cos in London town there are plenty of eccentrics out and about. Some of them are unconventional...some of them are mad.


I was about to cancel the ambulance for my next patient, a 34 year-old woman who was hyperventilating at work. She didn’t really want to go to hospital and she didn’t need to but the crew arrived before I had a chance to stop them and she agreed to be checked out by them, just in case. They managed to get her to consent and off she went.


Up on the third floor of a Government building I carefully assessed a 39 year-old woman who was having a miscarriage. The baby was dead in the womb and she knew it. She had insisted on carrying on with the pregnancy however and now it had reached its terminal point…and she knew that too. She cried a little and her pain was palpable. Her husband stood by her not knowing quite what to do and in these circumstances we (men) are quite useless.

She’s had a miscarriage before but she has also given birth to healthy children.

‘How many children do you have?’ I ask.

‘Thirteen’, she replies.

I have to ask her to repeat that.


The next call for a ‘chest pain’ patient was a drunken patient. The 45 year-old woman is a regular caller (as I discovered during a conversation with colleagues later on). She always claims to have chest pain. I went in to her flat with the crew and she was staggering about the place, laughing and shouting at us. She’d opened the door for us and when asked if she’d called an ambulance she simply said ‘Yeah, whatever’ and led us into the front room.

‘What have you had to drink?’ my colleague asked her.

‘A lot’ she says, grinning like a child.

She didn’t want to be taken to a certain hospital because her father and brother had both died there she claimed, as if the hospital was solely responsible for that and she would be next. Medical community vendettas against whole families are thankfully rare, so I was reluctant to believe her. The alcohol was a convincing factor - why do drunken women shout? When I patrol around the West End at the weekend it's almost always the female voices, shrill and very loud, that I hear without trying.


A 20 year-old female collapsed and had a fit at a local beauty school and a gang of wannabe beauticians crowded around a classroom door to check out the excitement. It took a large colleague with a broad foot to keep them inside where they belonged. I think beauticians are naturally nosey, like hairdressers. I never know when my next holiday is going to be but they insist on asking, like they want to join me.


Again, I wasn’t required for the 50 year-old woman with chest pain (on the same street as the fitting beautician, ironically) because the crew was on scene and dealing with it.


I had a long break after that and spent an hour or so chatting to my MRU colleagues and drinking coffee (none of which I had to pay for). Rest periods like that are unusual, so I was glad of it.


I ended my day with a 50 year-old man who was recovering from a fit on a bus. He was dizzy and post ictal and didn’t look well at all. I left the crew to persuade him to go to hospital because he was adamant he wouldn’t.

Be safe.

Anniversary

Early shift: Eight calls; two no-traces, one conveyed in the car, one assisted-only and four by ambulance.

Stats: 1 sleepy head, 1 DIB, 1 chest pain, 1 RTC with head, neck and chest injuries, 1 abdo pain vomiting blood and one dizzy person.


The anniversary of 7/7 (how come terrorist incidents happen on neat dates like this?) is always a sombre occasion in London but this year it was a very low-key affair and I think the public memory of the outrage is being diluted, which is a shame. Nevertheless, I stood over the flowers at Tavistock Square and closed my eyes to think back. I wondered when this would happen again and how many would be taken next time. I wondered if myself and my colleagues would be in the firing line and if I would ever be standing at a memorial for emergency services staff.


I was assigned another observer for my shift today – a trainee nurse called Sue who wanted to experience life on the road, so to speak. She was due to ride out on three days, one with me and the other two with crews. I got on well with her and the company was nice for a change. She stuck with me until early afternoon then went home tired. I have that effect on people.


The first of two consecutive no-trace calls was for a bus vs. cyclist RTC. The bus was still on scene but the cyclist, who’d been clipped by it, was nowhere. She’d left the area an hour before but nobody thought to tell us and the call was made by the bus company anyway.

The second call was for a 25 year-old male ‘collapsed’, which means anything from cardiac arrest to staring into space these days. He too was invisible when we arrived. Sue was definitely getting to grips with this whole paramedicine thing!


A 22 year-old near-faint next. I took her to hospital in the car because she was just plain tired and when I left her at the hospital she lay down on the waiting room bench and continued what she’d started earlier.


The crew was on scene for the next call – a 79 year-old female with DIB, so I wasn’t required and did a quick about-turn after checking this was the case.


Off to a local hotel next to treat a hard working 41 year-old Lithuanian woman who’d developed chest pain and had struggled to carry out her duties as a domestic all morning. She had no previous history for this and the call had originally been given as a faint, so the chest pain was a bit of a surprise when I was told about it. She was taken to hospital but was smiling through her concern.


Mr C. is still making his daily 999 calls and I thought I was off to E1 (a long way out) to deal with him again. This isn’t his usual area but it wasn’t long before I heard another call over the radio concerning him, so I guess he’s moving around for a break. I got cancelled on the E1 call thankfully.


The next call was for a 41 year-old female who’d been hit by a car as she crossed a pedestrian crossing on a busy road. The lights were in her favour by all accounts and the car, a private taxi, was travelling at 25 mph when it went straight through red and into her. She travelled up on the bonnet before landing hard onto the road. She had head, neck and chest injuries. My main concern was that she had some difficulty breathing and complained of a tightening chest but I couldn’t see or hear any evidence of a pneumothorax, although that didn’t mean one wasn’t developing. She was collared, boarded and taken to hospital rapidly with me attending to her while one of the crew drove my car for me. She arrived in a stable condition, although her chest still hurt. At least I didn't have to contemplate doing anything nasty to her if she'd deteriorated.


Then a short drive north for a 17 year-old with abdo pain who claimed he’d vomited blood. His mates were busily moping around the small flat, smoking and puffing out of the open window. I didn’t see the point because the place stank of cigarettes and blowing it out of the window made no difference. I was a little uneasy in the place to be honest, there were a few of these young guys around and more kept appearing from different rooms. I’m never comfortable when I can’t count the people around me.

Anyway, despite the lack of evidence that he’d actually vomited blood and the fact that he claimed many other injuries, including acute deafness in one ear, he was taken to hospital. Hopefully he’ll grow up there.


Sue had gone by the time I got my last job of the shift, for a 16 year-old female ‘not alert’ in a shop. I arrived to find a perfectly alert girl who had suffered a short period of dizziness. That’s all. I asked her if she needed to go to hospital and she agreed that she didn’t. Her dizziness had gone and she was fine. I think she stood up too quickly or saw the price of the shoes and ‘took a turn’, as my mother would say.

Be safe.

Local

Early shift: Five calls; all taken by ambulance.

Stats: 2 Head injuries; 2 EP fits; 2 cardiac-related.


First call of the morning and I’m on my way to a tube station for an eighteen-month old boy who has fallen on the escalators. He was actually being carried by his father, who stumbled as he tried to stop his young daughter from falling. On scene, the family were gathered around the ticket office and a concerned underground employee was on stand-by but all was well. The little boy had a minor scratch to his scalp and the bleeding had stopped. Mum had a grazed knee because she also fell as dad attempted his over-burdened rescue of his little girl. It must have looked like a comedy sketch as the whole family began to collapse on the moving stairs.


A 23 year-old epileptic had a ten minute seizure before recovering. When I arrived, the worst of it was over and he was confused but stable. He’d been up all night drinking and his friends told me that historically, that’s what usually triggers his fits. Strangely, I knew the answer to the problem but I thought I’d leave it to them to work out as he was taken away to hospital for checks.


Cardiac problems can cause faints and sudden collapses where the patient becomes less alert than normal. This triggers 999 calls from relatives and worried friends, as was the case with my next patient, a 70 year-old man with a pacemaker fitted who’d become confused. The crew was on scene and he was taken to hospital, just in case. I didn’t see his ECG because the crew dealt with him for the most part. Sometimes my patient contact time is fleeting.


Another epileptic was fitting in the street when MOPs came to his rescue. He’d fallen hard and now had a bleeding head injury which needed covering up. I had driven onto a newly concreted pavement area and was aware of how messy my uniform was getting. I’m not sure how the workmen (and women) will react when they return to complete the paving and see tyre marks and footprints all over the place. I might go back and apologise.


My second cardiac-related problem led to weakness and near-faint. The 59 year-old taxi driver was in a small London hotel where he stayed whilst working to raise money for him and his wife, both of whom stayed abroad pretty much all the time. His BP was high and his pulse was slow; he had a headache and his medical history intimated possible cardiac concerns. His ECG was normal however but he worried about not being able to get to work. His evening would be spent in hospital – his occupation could wait until a stroke had been ruled out.


All of my calls were within a mile of each other today; all in the WC1 or WC2 areas. The last patient was particularly impressed by the speed of my response (every so often a patient will comment on how fast we are at getting to them). Little did he know that I was at the station when the call came through and his hotel was around the corner – in fact, it would have been faster to walk to him because I had to drive all the way around the block and that cost me another minute.

Be safe.

Punk with a poodle

Night shift. Seven calls; one dead at scene, one taken in the car and the rest by ambulance.

Stats: 1 Asthma; 1 High temperature; 1 SOB; 1 Purple plus; 2 Chest Pain; 1 Hay fever (!)


I took the 28 year-old man with SOB and no history of anything to hospital myself because he’d had a recent dry cough and his temperature was high. I really didn’t see the need for an ambulance.


A cancelled call next (and one that I didn’t list above) for a man lying in the street in a sleeping bag claiming to have sunstroke. I asked Control if they’d read the description at all and when they did it was generally agreed that I’d be wasting my time as the weather was inclement.


An off-duty Patient Transport Services (PTS) lady was flagged down by a distraught mother who asked for help with her asthmatic 2 year-old daughter. I was called soon after and I arrived to find a non-asthmatic, happy child with a bit of a temperature. It was beginning to look like one of those nights.


Then I am asked to travel a long way north for a 65 year-old deceased female. I saw no sense in this but, as we were clearly short of vehicles, I didn’t argue the point and made my way there to find a crew already on scene by a few minutes. (You should skip this story if you have a vivid imagination and a weak constitution).

The lady had been found upstairs in her house by her daughter who’d been taken up there via a ladder and in through the small toilet window because the doors were locked from the inside and her mother hadn’t been seen for more than a week.

The daughter was now in a state of shock in another neighbour’s house because what she saw will never be erased from her memory.

I climbed over the back fence with the crew and we entered the house by the kitchen window. Nobody had told us exactly where to find the corpse, so we searched the rooms one by one until the smell from upstairs became strong enough to divert our attention to a bedroom. Inside was the putrefied and blackened body of a woman. She lay back on the bed, half-in and half-out with one slipper on. She had obviously been getting in or out of bed when she died very suddenly.

The smell of decay was so over-powering that myself and the male crew member had to cover our mouths and noses. The female crew member had problems smelling so she had no trouble with this, apparently. The place was hot and dark and more than a few flies were buzzing around. This is what the daughter had walked in to see. Her screams were heard down the street and nobody else dared enter the house until we arrived.

While waiting for the police we searched for door keys so that we could open the front door and allow them access but we couldn’t find any. Neither could we locate the back door keys. Both doors had been secured from the inside and both sets of keys had been so carefully hidden that, despite forty minutes of looking in every conceivable place, we ran out of options and had to exit the same way that we’d entered. The only other place those keys could have been kept was with the dead lady upstairs and none of us really wanted to go searching her body, especially as the flesh was in such an advanced stage of decomposition that it was falling off the bones.

Eventually, after an hour or so, the cops arrived and used their own ‘key’ to break down the door. They spent as much time as we had looking for the proper keys but came out scratching their heads just as we had. It was a mystery.


A 47 year-old lady with chest pain probably had a pleuritic problem rather than a cardiac one, so I left her with the crew after seeing that her ECG was normal.


A 32 year-old woman who denied having asthma was suffering an asthma attack; I could clearly hear the expiratory wheeze when I listened with my stethoscope, so she went to hospital for a proper examination.


Alcoholics who’ve been at it a while develop ‘dead brain’ signs: permanently slurred speech, loss of balance and co-ordination and frequent visits to hospital for ailments that are often wholly related to their habit. My next patient, a 31 year-old man, staggered to meet me as he waited in the street after dialling 999 from a call box and complaining of abdominal pain.

‘What seems to be the trouble?’ I asked him as I got out of the car.

‘Well, lots of things really…’ and he went on to list them. His abdo pain was the dominant complaint today but he had a host of other organic ailments to draw on should the need arise for a warm bed and a meal.

‘Have you been drinking tonight’, I asked stupidly.

‘Yes but not a lot’, he answered, unbelievably.

He was a tall, gangly man but he posed no threat to me and, although I was in a rough area at 5am, I didn’t feel worried about spending quality time with him until the ambulance arrived to save me. The conversation was dying by then to be honest and I really didn’t want to be chatting about family and holidays with him.


I saw the punk walking along Westminster bridge at stupid o'clock in the morning. I didn't take his photo because that wouldn't be nice without his permission (and he looked hard) but he led a large poodle along (a standard poodle I think it's called) for walkies and I couldn't help but smile at the contrast...it seemed a contradiction in fact. Still, it might have been his mother's.


I got to go home after trundling up to the City to save the life of a bus driver who was suffering from…hay fever. Yep, that’s right. He had the sniffles and was puffed up a bit. Oh and he had a blocked nose. Apart from that and his sense of urgency as he practically ran to the ambulance…

‘What about your bus?’

‘F**k the bus!!’

…he was absolutely fine.

Be safe.

Robot children

Early shift: Nine calls; one assisted-only, eight by ambulance.

Stats: 2 asthma; 1 assault; 1 fit; 1 chest pain; 1 trauma; 2 fainted and 1 ETOH (I might drop these stats...they seem a bit superfluous).


Regular callers are part of the job and my first call, to a 61 year-old man having an asthma attack was someone I recognised immediately, although I haven’t seen him around for a while. He’d told underground staff that he was having DIB and had forgotten his inhaler but when I saw him his breathing was fine and he perked up even more when the crew arrived to take him away. Funny that.


A 29 year-old woman was crouched in the hallway of an expensive building of flats, hyperventilating after allegedly being assaulted by the man who’d taken her and a friend in for the night. The call had stated she’d had an epileptic fit and she confirmed she suffered from this but I’m not sure a seizure had taken place at all. The man had punched her out of a stool in the kitchen after an argument and she’d collapsed to the floor (thus the ‘fit’ I guess).

Police were on scene when the crew and I arrived simultaneously but they’d left her on the ground floor landing whilst they attended to the assailant, who was upstairs in the flat. It took us almost 30 minutes to calm the woman down and by the time I left she was smiling and hugging her friend.


My second asthma attack was a non-starter. The crew was attending to the 36 year-old woman and I wasn’t required.


A 2 year-old boy had reportedly had a fit at home and his mother called an ambulance because it had happened before and nothing had been properly diagnosed. I found the child lying in the doorway of the flat as his mother looked down at him – she didn’t seem too worried. He responded immediately to my voice and the crew, who’d arrived with me, gave him oxygen. As with all cases in which children have had a seizure, my first job was to get a BM, which read low. I gave him Glucogel and he absorbed enough over a short period to bring his BM back up to normal but that wasn’t the end of the story.

I’d asked about the circumstances of the ‘fit’ and the mother described a kind of drop attack rather than a seizure. This wasn’t his first collapse and I was suspicious about other factors. Two other kids sat like robots in front of the television and they didn’t smile when I spoke to them (I’m obviously not that charming) but I noticed they were sitting rigidly, not relaxed. It seemed unnatural.

As we got the boy ready to go to the ambulance the mother screamed at her other daughter, her eldest, when she appeared at the front door. She left the teenager to take care of the two robotic children and accompanied us to the vehicle. I asked the crew to do an ECG, which isn’t normally done with kids but I felt these drop attacks might have a cardiac origin. As soon as the strip printed off we could see a problem; there was an irregular rate and a complex dropped every five beats or so. This could possibly mean an AV conduction problem but I’d have to wait until we got him into hospital to find out.

He remained irritable and lethargic all the way to hospital and I wondered if he had been born with a problem or it had developed because of other reasons which I’d better not speculate on here.

In Resus he was thoroughly checked out and his ECG there confirmed what we’d found – he had a sinus arrhythmia of, as yet, unknown aetiology. Whatever else was going on in his little life, I was never going to know.


A long drive to a place way outside my area for a 61 year-old man with chest pain who walked to meet me when I pulled up. He had that ‘regular caller’ look about him and after I’d finished my obs the local crew confirmed just how regular he was when they arrived. He’d given me a pain score of eight and a half out of ten, which was kind of a clue.


Mixing alcohol with drugs is never wise. My next patient, a 55 year-old man, fell into the road and smashed his head after washing down his anticonvulsants with vodka. His wife and daughter, who were on scene, weren’t happy with him and remonstrated with him as he was loaded onto the ambulance. Alcohol, drugs and an unhappy family - nice combo.


I wasn’t required for the 22 year-old who’d fainted with ‘breathing problems’. The crew was with her.


Next, a 55 year-old woman who passed out in a restaurant after a near-choking event. Her BM was high and her ECG was anomalous, so there were other reasons to take her to hospital, even though the food she had choked on had cleared and she was fully recovered when I arrived.


I watched a pedibike (it’s a kind of taxi bicycle) brake hard as it careered towards a car at traffic lights. These guys drive them around like idiots sometimes. This time there was a man and two children on board and the braking pitched the whole passenger area forward as the bike tipped over, spilling one of the little girls onto the road. The man wasn’t happy at all and shouted at the ‘driver’. Then he took his kids and himself off the contraption and onto the pavement, where he waited for a proper taxi. Pedibike man didn’t seem fussed at all.


Finally, a 50 year-old man ‘unconscious with head injury’ turned out to be an alcoholic with a skin infection (which was bleeding) who was trying to sleep in a public place (they never learn). The cops were with him when I arrived and they moved him on after a quick check of his condition. He staggered off like a drunken shadow and found a better, more private place to sleep.

Be safe.

Back from Croatia

Oops! Forgot to tell you all that I was heading back out to Croatia with some of my LAS colleagues...thus the disappearing act. I'm back now and you can check out the photo's taken out there on my facebook page. Again, great fun; a beautiful country full of lovely people but also very poignant, given what they've been through.

I'm back on duty too, so I have stuff to catch up on and new material to come no doubt.

Xf