The Pacifier (for a change)

Night shift: Ten calls; one assisted-only; one no trace and eight by ambulance.

Stats: 1 Faint, ?CVA; 4 eTOH including 1 with a head injury and 1 fitting; 2 Sober head injuries; 1 Assault with fractured cheek; 1 Chest pain.

A 55 year-old poetry publisher collapsed at a posh gathering of writers and associates – he appeared to have fainted and was recovering but his answers to simple questions like ‘what’s your name’ were slow and vague, so he was taken to hospital on the assumption that something else – something neurological – may be going on. Meanwhile, I went around the block twice trying to get out of the little square that I had become locked into. London is full of these quaint, traffic-unfriendly and annoying places.


My hand was gripped and warmly shaken by a 50 year-old drunken man whose two large sons had called us because their father was becoming difficult to handle at a train station. He smiled at me, shook my hand and then told the crew to ‘f**k off’ before the smile had left his face. Neat trick. Only playing the part of an evil Emperor or vast amounts of consumed alcohol can make that performance look easy.


Alcohol also makes people cry far too much when a few tears would normally suffice. In fact, crying for no reason at all is oft times part of the effect, as was the case on my next call to a 25 year-old female who’d had a little too much. She too had settled down at a station – underground this time – and she too became a completely different person when the crew took over from me. The thin, dreadlocked woman was taken away, weeping and moaning about stuff, only to turn around and start abusing the crew as soon as I had gone, according to the accounts I heard later. She was thrown out of hospital by security apparently. I never knew I had such a calming affect on emotional drunks. Usually I’m the one getting abused. Tonight made a nice change.


The serious call of the shift was for a 25 year-old male who was found in the middle of a very busy public place with a massive head injury - apparently he fell…allegedly.

HEMS was called for this one and there was a crew and another FRU on scene when I arrived. He was conscious but not in good shape. When HEMS pulled up in their distinctive Subaru, the team went with him into the back of the ambulance and I knew that they would probably RSI him for his own good (you can look up these abbreviations in the TPD glossary. Although by the time I’d typed that in I could just have told you what they meant. Never mind…too late).


A call from a phone box for an alleged fitting person turned out to be the invisible man having a seizure again, so I called that one a no-trace. Soon afterwards I was in a hostel holding down an alcoholic who was having his fourth seizure of the night in quick succession. I had to be very careful to avoid his size ten boots as they flailed around on his feet, looking for a yellow-jacket wearing target. Luckily, his aim was poor.


A 22 year-old whose girlfriend described his assault as a ‘pummelling’ stood inside a noisy club in the early hours nursing a broken cheekbone after someone laid into him for whatever reason is needed these days. He seemed like a sensible, fairly sober type of guy but I think he needs to have a word with his partner about her choice of words while he’s feeling sorry for himself. Outside in the drunk world, a large lorry is continually hooting his horn in anger at the empty ambulance (the crew are with me) on the road. They have parked rather inconsiderately and he’s not happy. How dare an emergency service vehicle park so that a large, smelly vehicle cannot pass! The ambulance driver should at least have spent time looking for a perfectly shaped area between vehicles before jumping out with his crew mate to deal with the call. I mean, someone could be held up for ten minutes by such antics. Hey, I’m being ironic and sarcastic incidentally. He wouldn't have been making that racket if it had been a police vehicle on duty.


Then I spent a long time looking after a 19 year-old drunken man who was lolling and vomiting on Leicester Square while his diminutive Chinese ‘friend’ kicked him in the back of the knees if he dared to stand up and stagger, ensuring that his legs buckled and he came crashing back down again – control restored. I had to warn the guy to stop doing it. His drunken mate already had a small head injury as a result of falling and the technique currently being employed to keep him in the same place until a taxi was hailed, wasn’t working to his benefit. I certainly couldn’t stand by and watch as he was repeatedly assaulted in the name of friendship.

I intended to sit and monitor him until he was scraped off the pavement and into a cab but as the hour wore on I realised he was going nowhere and was only fit for hospital, so I requested an ambulance for him and sat in the car, or hovered around him, keeping an eye out for any sudden deterioration. All he needed was a bed and a chance to sober up but he was too out of it to go home, especially with friends like the one who was coaching his knees to crumple.


I apologised to the crew when they arrived and the little Chinese guy, who refused to travel with his mate, mocked a phone at his ear and said ‘call me’ to his drunken companion. I thought they might be lovers the way he’d said it, then I thought the patient would never remember the emotion of it anyway.


Later on, when I’d recovered from my long stint of being a knight in green armour, I went off to a Red1 in Soho, expecting to find a corpse or as near-as-dammit lying in the street. Instead I found a crowd gathered around a young woman who’d slipped while running. She’d been unfortunate enough to run into a pool of cooking oil that had been left in the middle of the pavement by someone.

Police were on scene and blue chequered tape was being cordoned around us to stop people from walking into the same disaster area. The tape was tied around the wing mirror of my car for want of a better place. I felt offended... a bit.

The 25 year-old was flat on her back and absolutely covered in greasy, slimy oil. Her hair was ruined. She complained of pain but wasn’t specific – I think the shock of ice-rinking it along the pavement when she didn’t expect to and then landing unceremoniously on her rear didn’t do her confidence any good. She was sobbing.

She was still sobbing when she walked/slid to the ambulance.

My shift ended in the wee small hours with a 40 year-old man who just wanted to get off the cold streets for the night. He told the police he had heart problems. They didn’t believe him but we are not here to judge, so he was taken to a warm, safe hospital with all the others who’d gone before him.

Be safe.

Fragile

Night shift: Nine calls; one declined; one assisted-only; the rest went by ambulance.

Stats: 1 Assault with head injury; 1 ?Fit; 1 Unwell baby; 2 eTOH; 1 eTOH with Head injury; 1 eTOH with Facial injury; 1 DIB.

I took my first call without knowing what I was going to. This happens when a call is still in progress and FRED gets a bit over-eager to stop the clock. We get despatched with the address only and we are expected to run until further details are available. Unfortunately, on a number of occasions, I’ve arrived on scene before being updated with said details, so getting outside a dodgy housing estate and then seeing the words ‘do not enter premises – murderer inside’ can be the closest of calls. Okay, I’m only kidding about the example – there was no murderer and I’m sure my colleagues in the bunker would call me and give me the heads up, wouldn’t they? Still, my point is made.

So, I arrive and it’s an assault – a 40 year-old man has been hit over the head with a bottle. He’s very agitated, as you’d expect from a decent head injury but his shoulder is injured too and he complains loudly when it’s touched...or even looked at. The crew take him away, gingerly persuading him to do the walking because he won’t allow any sort of assistance.


Another call for a warm bed I think on the next job. A 35 year-old man claimed to have had two fits outside a bus station but he’s not epileptic and shows no sign whatsoever of having had a very recent seizure.

‘Did anyone witness your fit?’ I asked.

‘Yes, my friend did.’

‘And where’s your friend.’

‘He got on the train and went home. He said he’d send some money through the bank for me tomorrow, ‘cos I’ve got nothing.’

So, not a very close friend then, I thought.

The man was clearly on the street and needed a place to lay his head. It’s cold tonight and I don’t blame him. I just wish he’d be truthful with me.


On to a premature baby that’s being fed via a gastric tube and has been vomiting. Mum is worried and there’s a crew on scene when I arrive. I hear the story of this little mite’s problem birth and the host of medical issues that are currently cramping her life and I feel like crying. I do the BM and her little foot keeps bleeding, regardless of the pressure I put on it. I feel guilty about this and eventually, after five minutes of pressing and re-pressing, she stops leaking. Now I can go without feeling that I’ve added to her misery.


A 61 year-old woman who was ‘shaking badly’ had nothing wrong with her and her family gathered around the bed as she jerked about for no reason. It cost an ambulance before she declined any aid because she’d been exposed. I will never understand why people do this to us.


If you call us don’t expect to be taken to the hospital of your choice. Like the 54 year-old alcoholic who’d had a ‘disagreement’ at the local hospital and now wanted to be taken to another one, miles away. He complained of vomiting blood but there was no evidence of this and he’d been waiting in a callbox for me to arrive. I left him and his insistence with the crew. I'd been a target for the local louts in this estate before and I thought better of sitting around while they armed themselves again.


Another drunken person, a 22 year-old woman, fell off her bike and ended up being collared and boarded by us when we arrived. She had fallen hard enough to do damage to herself – now she had neck pain. She was also drunkenly agitated, which makes things a lot worse to manage.


Still on the drunken scene, a 68 year-old man was found collapsed after falling and hitting his head on a wall by passers-by, one of whom was a ‘qualified first aider’ and who insisted that he had ‘a right to be there’ even though I hadn’t actually spoken to him - nor had I challenged his rights to do anything. The man on the ground was very, very drunk and was miles from home but he refused to go to hospital and gave the crew a hard time. He stormed off and became my next call when he was found lying in the middle of a busy road with fresh injuries to his face, after repeating his previous performance. This time, however, he was lucky not to be killed.

Again, I got abuse from a person in the know, when I proceeded to get the patient off the road and into the ambulance without collaring him. I knew he’d just fallen because I was told he’d just fallen – he hadn’t been hit by a car and hadn’t crashed down from a height but that didn’t stop another bystander from shouting at me and describing to all and sundry how I was doing it all wrong. They'd never do it that way on the telly.

Next time, I’ll wait in the middle of the road, struggling with a drunken, combative patient as I put a collar on for no reason and get me and the patient killed by a passing car/truck/bus/bicycle. That’ll teach them!



In the early hours I was called to an emphysema patient who had DIB. He was standing outside his flat, leaning against the railings. He’d been asked politely not to move but he’d insisted. I had to shoo him back inside and carry out my obs while he recovered from the distress of moving when he had very little oxygen to keep him going. His flat smelled strongly of fresh paint but he denied he was doing any decorating – the doors were off their hinges and the place had paint lying around (big clue). Fresh paint fumes are never good for those of a clinically fragile pulmonary disposition. His sats were dreadful but as soon as he went back on his home O2, they improved. The crew took him away to hospital and out of the danger zone. He was, all in all, a thoroughly nice chap.

Be safe.

Stone cold

Day shift: Six calls; one false alarm, one hoax, one treated on scene, one cancelled (I got lost) and two by ambulance.

Stats: 1 Hypothermia; 1 Faint, 1 Hypoglycaemia.

Being a professional alcoholic and spirit-gel stealer/drinker means that, as an occupational hazard, your body won’t survive normally survivable things…like cold weather. My first patient, a 30 year-old man, was discovered lying on the freezing ground in a small garden by Lambeth Palace. If he’d been sober, he’d have had the sense to move somewhere warm, or cover himself up but he didn’t. He probably thought the mixture of Lucozade and alcohol-gel would suffice for insulation.

A passer-by on his way to work had the good heart to stop and ask if he was alright. On getting no response and feeling how cold the man’s skin was, he decided to dial 999. This action probably (more than likely) saved the alcoholic’s life. When I arrived he was so cold that his joints were bent inward because the ligaments had contracted and he was barely conscious. His temperature read 32 Celsius - he was definitely hypothermic and as soon as the ambulance arrived, which seemed a while, he was taken straight into the warm and then rapidly to hospital.

I would have given him no more than another hour or two out there before he died. That little park is in the area of nobody’s business at that time in the morning, so he was very lucky to have been found and even luckier to have been approached.

Lambeth Palace has several CCTV systems and one of the cameras spotted me outside the premises while I did my paperwork. I was also admiring the brickwork of the building and thinking about the men who laid them. The entrance door is tiny and people of that time were generally smaller, so my mind could imagine dozens of five-footers working up on wooden scaffolding during the construction of this magnificent building. Anyway, one of the guardians of the palace came out to check if everything was ok and I told him I was just doing my paperwork – that reassured him and he went back inside. Only then did I wonder why there was no camera covering the park, which is directly inside the grounds.


I spent twenty minutes trying to locate a man who’d been hit by a fork lift truck. I was in an area that was unfamiliar to me and a railway line stood between me and wherever I was supposed to be, according to my mapping system. Despite further information from Control about where I was (which I already knew) and a fruitless scoot around, I was cancelled when a crew arrived at the correct location – a local crew with better knowledge of the area I presumed.


A suspect vehicle near Buckingham Palace sparked a security alert and a cordon was set up with me and a MRU inside it, just in case. After waiting with my colleague, the police and fire crews long enough for a few hundred tourists to gather and start asking the same questions over and over again, I was cleared to go. The dodgy car was safe apparently; just badly parked. I bet a lot of our visiting guests think we are a bit over the top here in the UK when it comes to illegal parking. Where they come from a ticket would usually suffice.


A new face to the street-sleeping scene next and I felt sorry for her to be honest. She admitted to drinking a lot recently but that she wasn’t an alcoholic. She hadn’t eaten for three days and now she felt ill and cold. I found her trying to keep warm under her thin jacket on the Strand. A rough-sleeping friend was helping her but he was also trying to flog copies of The Big Issue so that he could eat too. Busy commuters have little time to buy magazines for the sake of it, so he stood for a long time as I tended to his acquaintance.

She told me she’d been on the streets for years but had just arrived in London (yes, even rough-sleepers migrate) from the coast. She was genuine and obviously unwell, so a trip to hospital was on the cards, along with a meal if possible.

For the record, I help where I can by giving whenever I can. I have a healthy respect for most rough-sleepers; they’re not all drug addicts and drinkers. I was one myself for a short time.


My stand-by on Trafalgar Square was spent chatting with a FRU/flight paramedic from Sussex. We talked about the job, the wages, the problems and the politics. We agreed that everything was pretty much the same but that he had the seaside. We have seagulls here but they are scavenging idiots and have no idea where the sea is. They think they are pigeons ‘til they speak.


My no trace hoax call was a Red1 for a ‘male lying on the ground’ which doesn’t say a hell of a lot about anything. It was hardly likely anyway because the street he was supposed to be lying in was packed with people and none of them was panicking, waving, staring or referring to anything vaguely ‘dead’. In fact, my intrusion with yellow car, blue lights and loud siren made most of them plug their ears, shoot me looks and scurry away for fear that I might be coming to take them away. The call description contained the line ‘caller hung up’. Well, of course he did.


Green Park underground station has one of the longest walks I’ve experienced at a station, from one area to the other. As usual my patient, a 25 year-old female who was ‘hypo’, was at the far end of the complex and me and my heavy bags were much fitter and slimmer by the time we reached her. She was an anorexic Polish girl with a recovering BM after her near-collapse. She had a bar of chocolate now, courtesy of the underground people (the moles) and she had no interest in me, my bags or the safety of a London hospital. In return I had no real interest in struggling the quarter mile, or whatever it was, through corridors, steps, multiple flights and bustling, jostling people while I carried her.

When the crew arrived I explained that the lady had gone and was fully recovered. They too had realised the ordeal we’d have if she’d needed carrying. We agreed between us (not that I’d ever work with this crew at the same location again) that the best way to move a patient in this complex was by train. If we had someone really ill, or being resuscitated, we’d commandeer a train, load the patient onto it and scoot down the line to the next platform, where unloading would be much easier. It was initially a bit of a joke but the more I thought of it the more I realised it was a sound idea. In fact, I wouldn’t be surprised to learn that someone else had already done it in the past. If not, then I claim sole rights to it (ok, me and the crew).

For the many people who emailed and commented about the kitten in my last post - HIS name is BEAR and he belongs to two very good friends and colleagues of mine. I might start a special 'cat's corner' section for you lot!

Be safe.

Climate change

HEMS has a new recruit!

Day shift: Six calls; all by ambulance.

Stats: 1 Stabbing; 1 unresponsive person; 1 Broken hip; 1 Cardiac arrest; 1 anaphylactic reaction; 1 Non-cardiac chest pain.

The weather is turning cold now and the week has been busy with ‘proper’ calls – the kind of jobs you get when the winter depression sets in.


Police arrived after the ambulance and me to a 21 year-old man who’d been stabbed in the hand during a robbery at his hostel. The injury wasn’t serious but the assault was and the cops started looking for the assailant as soon as they had a description. It was very early in the morning and I wondered at the mentality of someone who goes around stealing people’s stuff then stabbing them before breakfast.


Lying on the ground in a park was a 30 year-old man who’d been found by the police. The crew was on scene just ahead of me and the man on the ground was conscious, although he couldn’t or wouldn’t open his eyes. It was clear he was keeping them shut deliberately – you can tell by the way the eyelids tense. Nobody knew how long he’d been there or what his problem was but we managed to establish that he was Romanian and probably homeless. He may have been using the system to get a warm bed for the day. To be honest, moan as I do about the abuse of our ‘sponger-friendly’ system, I can’t blame someone for trying to get out of this freezing weather.


I was asked to support a crew on scene with a 92 year-old woman who’d fallen at home and broken her hip. The attendant is a paramedic but is not yet registered, so can’t give drugs or perform invasive procedures without supervision, so I took myself up to the estate where they were and simply showed my face so that the paramedic could get on with her job. It can take weeks or even months for a newly qualified paramedic to get registered and during that time they cannot practice, even though they are perfectly capable.


I had just been cancelled on a Red1, ‘Cardiac arrest’ call because a nearer vehicle had become available when I received a Red2, ‘ineffective breathing’. These calls usually convert to Red1 cardiac arrest and this one followed that pattern a few seconds before I arrived on scene. The ambulance was pulling up with me but the crew hadn’t received the update, so I let them know that it was now a suspended.

Upstairs in the building, a 66 year-old man lay on his back where he’d fallen six or seven minutes earlier after struggling to breathe. Nobody had carried out CPR but there were at least half a dozen people around in the room, which was some kind of office.

I worked with this crew on the hotel cardiac arrest – the one we saved – and I have worked with one of the crew on at least three of these in the past, so we knew the routine and settled into it very quickly. Shocks were delivered, drugs were given and his airway was sorted out when it became difficult to manage, although nowadays my brief is to concentrate on the defib, drugs and fluids. The airway is not as important as it used to be.

A second crew was requested early on but nobody appeared until we were preparing to move the man and he was strapped into the chair. A hysterical relative suddenly appeared and had to be gently moved away and no matter how many times the people around us were told to leave the room, they persisted and hung around the doorway, causing obstruction for us when we wanted to get the patient out quickly.

The second crew helped us to get the man down to the ambulance and we continued CPR all the way to hospital, at one point with me on the floor after I’d been thrown there by the movement of the vehicle.

The patient arrived at hospital in the same condition in which we’d found him and after a few more minutes of CPR, the doctors called it.

If you come across a cardiac arrest and you have any idea about CPR (you don’t have to be trained formally) – please try. If you leave someone lying on the ground for six minutes before anything is done, then don’t expect a survivor. Any CPR is better than none and mouth-to-mouth isn’t necessarily that important (recent research has shown), so start pumping the chest until we get there. I would never forgive you if you let my mother lie there without help for so long.


A car pulled into the pavement just outside the Houses of Parliament and the security people got nervous. Inside was a 51 year-old cancer patient who was having a severe allergic reaction to something she’d eaten. She had a history of anaphylaxis and now she was scratching so much that her arms and neck were grazed and gouged. Her throat was closing and she was panicking when I got to her.

I started her on a nebuliser and was about to give her an injection of adrenaline when the ambulance pulled up alongside. The drug was given a few minutes later when she’d been moved to the trolley bed. Then off she went on blue lights to hospital.


I ended my shift at a restaurant in Leicester Square, where a 25 year-old member of staff was complaining of chest pain. A couple of questions about the nature of the pain and a few basic checks convinced me that the discomfort was probably not cardiac-related. His age and demeanour helped confirm that but once the crew was on scene an ECG was carried out, just in case.

This job was behind my usual stand-by location in this area. I only had to move the car from one corner to another – another ORCON buster. I expect my medal’s in the post.

Be safe.

The glass woman

Day shift: Nine calls; one treated on scene; one arrested; one declined aid and the rest by ambulance.

Stats: 1 EP fit; 2 Falls - one with facial injuries, the other with multiple fractures; 1 Human collision with minor injuries; 1 Drug o/d; 1 Chest pain; 2 RTCs - one with minor injuries, one with no injuries; 1 Self-harmer with cuts.

A busy day then.

Morning rush hour and the cafes are full of people buying their first cup of over-priced coffee and perhaps a muffin. In one of these places a 30 year-old woman has had a fit and is now lying on the floor with a FRU colleague in attendance. I’ve been called because a ‘Hotel’ (our term for a paramedic) must also be on scene when someone has or is having a seizure, in case drugs are required. The lady was post ictal but recovering and I did nothing but watch and wait for the ambulance.


Then onto the cold streets for a 75 year-old woman who stumbled down a step and landed on her face, knocking two of her front teeth clean out and damaging her nose and mouth. A first aider had stopped to help and when I arrived, her ungloved hand was holding a dressing under the poor unfortunate lady’s nose as it dripped fresh blood.

I had a look at her injuries and checked that she hadn’t hit her head and that she didn’t have any medical conditions that could have either contributed to or been exacerbated by the fall. Her friends were milling around her and I think they had plans to enjoy the day in London (they were all from up north).

Once the bleeding had been controlled, I asked to see the lady’s teeth. They were long and intact. I wondered how such long teeth could come out of such a small person’s gum but I guess at that age nothing holds firm. I asked the first aider, who was keen to help, to get some milk and she went to the trouble of buying some from the local Tesco, which was nice. I transferred a little milk into an empty water bottle and plopped the fangs into it. Hopefully they will remain in good condition and a dentist may, or may not, be able to put them back into their sockets. In the meantime an ambulance arrived to take the lady to hospital.

‘You need to get your injuries checked out at hospital’, I said.

‘Oh, no thank you’, she replied.

There are people who would rather not ‘bother’ the NHS and there are those who, with no reason to, continually harass it. She didn’t want to make a fuss but off she went, after a little persuasion.


Two 6 year-old boys ran into each other at school and the crew and I decided they would live. One had a cut lip and the other had a tiny cut to his head, so I left the crew to it and made my way back to my own area after the long trek south. I teach first aid in a lot of schools each year and the staff are becoming less able to cope with the most minor incidents because they are worried about parents suing them or something. I advocate calling ambulances only where life, limb or skin is at risk, where there is great pain or doubt about a medical condition. Otherwise, if a child bumps his head or cuts his lip, deal with it. A 75 year-old with chest pain needs an ambulance more than a 7 year-old with a bruised leg.


I wasn’t required for the 30 year-old methadone user who’d overdosed. A crew and a MRU were already on scene.


As I travelled back I saw a couple having an argument in sign language. It was heated but you could only tell that from a certain angle. Strange and interesting at the same time.


I had to compete for road space with an Armed Response Unit on the way to the next call for a 40 year-old man with chest pain. Of course, the cops won and I found myself ten seconds behind the ambulance, so I wasn’t required. Cops with guns always win.


‘I thought I was going to go under’, said the cyclist who’d just been knocked off his bike by a bus. He was shaken but, apart from minor cuts and bruises, unhurt. The whole thing was witnessed by a loud and vociferous woman on the pavement. She insisted on relating the whole tragic tale of how the bus driver was entirely to blame and how he didn’t even look before cutting in on the poor unfortunate two-wheeled man. ‘Don’t listen to her, she’s drunk and she’s mad’, the bus driver told me. I didn’t know if he knew her personally or this was his bizarre way of getting out of trouble. Perhaps the International Bus Driver's Manual states that, 'should a person accuse you of bad driving, they are probably drunk, mad or both because there is no way that you can be to blame'.

However, that particluar road, on a very busy intersection, is notorious for cyclists who speed through the red lights, crossing moving traffic. Even as I stood there, with the bendy bus practically parked in the middle of the road and my vehicle positioned so that a block was created, cyclists and moped riders were attempting to scoot through the small gap left between our vehicles and the barrier. It was ludicrous.

Last week at this very same junction a cyclist was crushed to death under the wheels of a lorry. There are still signs up in the area notifying everyone of the ‘fatal collision’ that took place. I was working in the control room when I saw the call come in; ‘person lying on the ground. CCTV confirms he is not moving’. Multiple calls came in for it and one person, cycling to work, never made it.

Clearly, the danger for cyclists is extreme enough without some of them increasing the risk by riding around like lunatics.


My next call cost me an hour but it was needed. An 83 year-old lady had fallen on an underground train and she’d broken her leg apparently. A medical student was taking care of her when I arrived and the train had been kept waiting, full of passengers, on the platform until I got there.

The lady was in pain and, after clearing the carriage of people, I examined her leg, which was being kept still by another passenger who’d volunteered to help. The entire limb wobbled like jelly below the knee and it was clear she had broken both Tibia and Fibula at the joint. She also complained about arm pain and I found a fracture at the distal end of her Humerus too.

The train had pulled away from the platform, a movement that usually starts with a sharp jerk and the lady had lost her balance and gone over onto her left side, landing hard on the floor. She fractured like she was made of glass and only one disease fitted the bill for this scenario; osteoporosis. I managed to get her friend, who was travelling with her, to confirm that she had ‘brittle bones’ as the crew arrived, along with the British Transport Police and more tube staff.

As the crew helped with pain relief and splinting, I asked to have the next carriage cleared because people were still peering in at the poor woman as she lay on the floor. I had cut through her tights in order to examine her leg and her dignity was already at risk. The police completely cleared the train however and as we developed a plan for her removal (no escalators or lifts at this station), the entire station was shut down, causing chaos I would imagine, with mid-afternoon travellers.

Once the lady’s pain had been controlled and her leg and arm splinted, we carefully moved her onto the chair (her leg was supported by a police officer) and we carried her all the way to street level using the stairs. It was an awkward and clumsy lift but we reached the outside world and were greeted by the sight of dozens of people standing patiently behind the entrance barriers. I understand the frustration that many of them felt – we had probably upset a lot of timetables but I heard no complaints and saw no aggrieved faces. If you were one of the people waiting for us to take this lady out of the train, thank you for your tolerance. Thanks to the police officers who helped. All in all it was a good team effort and made my day worthwhile.

The lady’s injuries were confirmed later on.


An assault turned out to be a case of self-harm. A drunken 25 year-old man was seen staggering around Victoria with blood dripping from his hands, so I was sent to check it out and cautioned to wait for the arrival of the police. The area around Scotland Yard is very sensitive and its not hard to find a gun-toting cop, so I wasn’t surprised when more than a handful of uniforms appeared for this one man. He was surrounded by at least eight officers and had two restraining him in cuffs because he was more than a bit feisty. His hands had been cut open by a ragged, sharp lager can that he’d ripped open. He had walked along the street carving it into his mittens until they bled from lacerations on the fingers and palms.

A police officer had already bound one hand up and I looked at the wounds, determining that they weren’t serious. The crew was on scene with me and the attendant decided the injuries weren’t worth taking to hospital – the police had arrested the man and were happy to continue his journey to jail instead of hospital.


At a junction in Knightsbridge, a van flashed a motorcycle and vice versa. The confusion caused by both signals meant that each driver, thinking he was being given right of way, moved at the same time, colliding at the centre of the road. The biker was dragged underneath the van and the front wheel of his machine was crushed and bent by the force. He, however, survived and when I got on scene he was standing on the pavement, mobile phone in hand. He’d refused the help of the FRU pilot who had arrived before me and there were no other casualties.

I helped a police officer to move the motorcycle off the road but because its wheel was bent, the heavy vehicle was difficult to manoeuvre, so my FRU colleague helped. He forced the handle bar on one side down in order to straighten the wheel but this meant that the bar I had my hand on was forced up and into the broken visor section, crushing my hand and cutting it open. I had to yell twice before he realised what he was doing. It hurt, I can tell you. Thus, I finished my shift and went home injured in the line of duty. Not that this washed with my DSO when I jokingly tried to use it as an excuse to stop early.

Be safe.

Dead in the shed

Day shift: Five calls; one taken by car; one dead at scene; three by ambulance.

Stats: 1 Faint; 1 ?EP fit; 1 eTOH fit; 1 ?Cardiac problems; 1 ?Suspicious death.

It’s getting darker and colder – winter is approaching and within a few months that means the season of goodwill and joy to all men (and women) will be upon us. Oh, wait, I mean the season of drunken debauchery and copious public vomiting. Yeah, that sounds more like it. I'd like to think the new TV campaign 'why end your night like this?' will have an impact and reduce the number of stupid people but I doubt it, especially after being called the 'booze taxi' by a passing Hen group in Leicester Square, one of whom went on to say 'I'll be seeing you later'.

Until then, I am working my way through the shifts with the usual routine alongside my brave and noble comrades.


A 31 year-old Norwegian man fainted twice at an underground station and he was recovering well when I got to him, although I advised him to go to hospital, or at least have an ECG done. He seemed keen to get on with his day and his colleagues stood around outside the station’s medical room waiting for word that he was okay to continue with them. BUT, two faints in a short period where no previous medical history exists can be ominous and so the crew took him to the ambulance and I left them to persuade him not to work today but to get his health checked.


Lying on the floor of her office was a 24 year-old American woman who’d had a fit, although nobody had actually witnessed it. She’d been found collapsed and confused and the assumption had been made. It turns out she has fitted once before but it had never been diagnosed, or at least she wasn’t sure if it was or not. She did have medicine for it but she couldn’t recall what it was or precisely why she took it. She was definitely confused.

It took more than 30 minutes before she made sense again and the same amount of time waiting for an ambulance before I decided that, clinically, she was fit enough to travel in the car.


My next fitting patient was lying on the rain-soaked pavement of a busy street and I took a short handover from an umbrella-bearing man who’d stopped to help him when he’d seen him suddenly fall down and have a seizure. I asked the man with the umbrella his name and thanked him for his help, while I covered my patient in a blanket and did my best to keep him (and myself) warm and dry. People rushed by with vaguely interested faces on them and I had neutral emotions about London for a time. If it hadn’t been for the umbrella man (and one other who’d left when I got on scene) this poor fitting person may well have been left to it on his own.

Umbrella man took his leave as soon as I was into my obs and once again I thanked him for his kindness. Then I spent fifteen minutes or so on my own crouching over the semi-conscious patient as he began to slowly recover on oxygen. Legs and feet passed within inches of us but they were all in a hurry to get somewhere. The people at the top of them were only marginally curious and the more hardened commuters defied their instincts and ignored the obstruction altogether.

Once the patient was able to speak, I asked his name and he gave me the same name that umbrella man had given – how unusual, I thought. The ambulance noisily pushed its way through the rush hour traffic and arrived just in time for my interest in the name coincidence to evaporate. A bed was brought over and the patient was loaded on board.

He was an alcoholic, we learned and he hadn’t been drinking for a while, so his fit was probably the result of withdrawal. At least he was out of the cold, rainy morning...as was I.


Another person who fainted twice in a short period of time was a 71 year-old Indian lady, whose daughter was very concerned about why this was happening. I would have reached them both quicker if the staff at the shop (I wish I could name it) had bothered to meet me and guide me to them but they were all too busy selling stuff to customers and I entered completely unnoticed by some and ignored by others. I had to approach one of the counters and ask where the patient was. I got a shrug of the shoulders and a blank, disinterested look. Only then did the woman’s daughter come up to me herself and show me where her mother sat.

The lady had fallen ‘like a stone’ according to her daughter. Once after walking around and again when she got off the bus. She had hurt her knees as a result but I was more concerned with why she was passing out.

A stoical woman, she showed little interest in going to hospital and I had to persuade her, with the help of the crew, after her ECG had been done. It looked like she may have a heart block, a cardiac condition that would result in faints. She took our advice and I left the scene knowing that if I was wrong at least she’d be properly checked out.


A Red1 for an ‘unconscious’ man, ‘not moving’ became a cardiac arrest with ‘caller declined to start CPR’ and I was on my way to a possible suspicious death. We are not officially allowed to state that something is suspicious but we can determine whether a death merits investigation or not.

The man had been found by his neighbour. He was on his knees and bent forward in the corner of a little brick shed in his garden. He had been preparing to paint it but not a drop of the stuff in the tin was touched. The ambulance crew had arrived on scene with me and as we approached from behind, we could tell he was dead.

He had a head injury and there was a good sized pool of blood on the floor where his head was resting. We had to move him in order to establish that he was beyond help, so we pulled his body over on to its back and during this process we saw enough evidence to support an evaluation of death - Post Mortem staining all over his trunk and head. Asystole was established over two minutes and I recorded a time, pronouncing him life extinct.

The police were called, as is normal under such circumstances but closer inspection of the head injury gave me cause for concern. I can’t describe the wounds in detail but I will say that I wasn’t sure if they were consistent with a fall post cardiac arrest. The police agreed and CID was brought in to investigate. It would be up to them and the Coroner to decide whether he’d died naturally or not.

Be safe.

Foul

Day shift: Five calls; one taken by car; four by ambulance.

Stats: 1 Mental health issues/drugs; 1EP fit; 1 Abdo pain; 1 Haematuria; 1 eTOH.

It’s 6.30am and there’s a half-naked woman running around outside a club. The police are on scene and I’ve been called because they think she has mental health issues. She has come out of the nightclub, pulled her trousers down, removed them completely and left herself exposed in a T-shirt and knickers for the world (and their door staff) to see. Clearly she has issues of some kind.

She may have taken drugs and she is clearly unstable because she fights the police when they try to move her to the ambulance. I requested a female crew (or at least one female on board) because this would be a tricky one for an all-male crew. She won’t allow us to cover her up and keeps ripping the blanket away.

I leave the crew to sort it out and a police woman stays on the ambulance with them for extra security because she is behaving very strangely and nobody knows what she’s capable of doing. For this reason, she’s handcuffed.


A 29 year-old woman had an epileptic fit at a hostel but she was recovering when I arrived and a crew was with her, so I wasn’t required.


Abdo pain next and a 29 year-old shoe-shop worker was lying on the bench in the middle of her store (now closed due to ill person inside) when I arrived on scene. After a short chat and some basic obs I persuaded her to sit up. I don’t like it when patients loll around while I’m trying to help them – I don’t mind if they are really ill but this young lady, with her reported pain score of 9/10, was still capable of smiling and talking without dropping a word when she referred to her male colleague in the shop.

I gave her entonox and decided to take her to hospital myself, rather than wait the twenty minutes or so that I would have to endure because there were no ambulances available. There was no vomiting, no fainting, no medical history and no reason for me to waste a resource when I could pack her off myself, so I did.

She managed two phone calls on her mobile during the trip and only used the entonox for her pain when I reminded her that it was there if she needed it.


One of our frequent flyers, let’s call him ‘M’ generated a 999 call from an Ann Summers shop in Soho. He was lying face down on the carpet, just inside the doorway and strangely, there were no customers. He was drunk, smelly from the streets and was now urinating frank blood, which is why he requested the ambulance by being dramatic and falling into the shop. This is what he does and he has been doing it for years. The only time he isn’t abusing us is when he’s in prison…for abusing us.

I picked him up and persuaded him to get out of the store. He demonstrated how genuine his condition was by putting his hand down into his trousers and producing two bloodied fingers – ‘See, I told you I was pissing blood!’

Although it’s always nice to have evidence and to be sure of a diagnosis, I wasn’t really impressed with him, so I sat him in a corner and called Control so that the ambulance could be hurried up. Unfortunately, we were fresh out of ambulances at that particular time and I knew this guy so well that I put in a request for special treatment because he was liable to become aggressive and violent if he waited too long. He has attacked me in the past and it would suit him to be back inside, so an assault on me would buy him some time in the warm as winter approaches.

Control sent me a CRU as back-up but this just made things worse because M hates this particular CRU colleague, so he shouted, pointed and generally made it clear that he wasn’t happy to see him. Now I had an irate, drunken and potentially violent man stomping around the area. I had asked the cops, who’d turned up to see if I needed help, to leave me to it, on the basis that if I kept it nice and one-to-one, M would be quiet and compliant but now I needed them because his behaviour deteriorated as time went on.

An ambulance was despatched after twenty minutes or so and I asked a police officer to come and stand over him as he ranted and swore and thumped public property in an effort to show us how much he hated peeing blood. At one point he stood shouting his pain at me whilst drinking a lager that someone had donated in order to shut him up. Then he lit a cigarette and puffed at that until he collapsed again.

‘Why is it doing this to me?’ he wailed as he looked at his pint. I prayed that he’d answer the question himself and see the error of his ways but I may as well hope to win the lottery twice in a row.

My adventure with him ended when the crew turned up and he became a lamb. The appearance of transport to a free bed and perhaps an overnight stay has that effect on him. My years of dealing with him have taught me never to trust that quiet side of him because if I do, I will end up getting hurt (and I don’t mean my feelings).


Just to help me on my way home, the last call was to another drunken man. This one was slumped outside a Pizza Hut and they simply wanted shot of him because there were paying customers inside, eating their dinners. Fair enough; I wouldn’t want to be eating an over-priced pizza meal in plain view of an alcoholic who’d urinated all over the pavement and wasn’t even good humoured.

The crew was on scene when I arrived, so I assisted them in getting him on board the good ship NHS ambulance for his ride to a better place (where the food is free). As his obs were being done he helped us out enormously by passing the foulest and most persistent gas I’ve experienced in a long time. The vapour was actually sticky and couldn’t be removed from my uniform for hours afterwards. Not only did he offend us once to the point where the ambulance doors had to be flung open, he decided to repeat the performance again and again. This man had a real problem keeping it to himself. Jobs like this make me so glad I’m on the car; I can get away from it, the poor attendant had to stay in the back with him all the way to hospital. He will no doubt have been put off eggs for life.

Be safe.