Glassed

Trafalgar Square attracts all kinds of people! (Lottiecam)




Night shift: Nine calls; one false alarm, one treated on scene, one declined and the rest by ambulance.

Stats: 1 Faint; 1 Hyperventilation; 1 Cut throat; 2 eTOH; 1 Chest pain; 1 Coughing blood.


A 65 year-old Northern Irish woman fainted in a restaurant as her family looked on but was recovering well when I arrived. This is a common occurrence; the stomach requires more blood when a large meal has been consumed, so there tends to be a drop in blood pressure in some people – this causes light-headedness or fainting.

The patient was a type II diabetic but her BM was normal. She was taken to hospital for further checks just in case.


The false alarm was for a 20 year-old Chinese man who fell asleep (drunk) in Leicester Square’s park, prompting a Red1 ‘cardiac arrest’ call for some reason (well, the usual reason – nobody bothered to check if he was breathing). I sped to scene as if it could be genuine (you never know) but it wasn’t. I arrived to find a stressed out park security man puffing his way through an explanation that the man on the grass ‘was not responding to anything’. Well, he responded to me immediately and the bemused and embarrassed tourists around him (who had also thought he was dead) slunk off to a safe distance.

‘Do you need an ambulance?’ I asked the sluggish little man.

‘Yes I do’, he slurred.

‘Why?’

‘Because I can’t move. I can’t stand up.’

You also can’t tell the truth, I thought. It crossed my mind that he might recognise it if he crouched and it ran in like a rabid dog and bit him on the arse but luckily that wasn’t necessary. As the sirens of two approaching ambulances (yep, two – ‘cos he’s dead remember) reached my ears, he stood up (not bad for someone who is paralysed) and walked off to find the toilet. And just to prove that he was more sober than drunk, he walked into the Ladies’ loo, corrected himself, u-turned and found the Gents. I remained in place, arms folded, as if I’d been stood up on a date. ‘Tsk!’ said I. ‘Tsk’ said the embarrassed tourists, some of whom were also lying on the grass but weren’t dead.


I overheard a funny little exchange on the radio after this job. A crew requested police to scene for a call they were running on; the call descriptor had stated ‘violent’ and so the dispatcher obliged and said the police would be sent. A few minutes later and I heard this...

Despatch: ‘Oh, sorry, police aren’t needed on this call. It actually states that he has diarrhoea. And that it is violent. He has violent diarrhoea. Sorry!’

Who the hell describes their runny number two’s as violent? Hilarious.


A stupid 21 year-old betrayed his youth and masculinity by refusing to stand up or walk properly because he was panicky. The call had been given as DIB but it was just another hyperventilating person who wouldn’t listen to the advice he was being given about breathing slowly. His work colleagues were around and so he continued to parody the dying swan for their benefit and although I understand the struggle of a first-time panic attack, his performance was not in tune with his condition at all.

I sat and chatted to a very good friend of mine who was leading a training crew. They sat in the back with the man until he pulled himself together and we jawed about life and the pursuit of happiness. As you do.


The serious call of the night was next up and I got lost in the traffic and roadworks (including several blocked off roads and diversions). It was for a 22 year-old woman who’d ‘cut her throat on glass’. These calls tend be something or nothing, so I went as if it was something, to be safe. I should have been there two minutes earlier than I actually was and it’s frustrating that the need for new water pipes is a potential for loss of life as a result of emergency vehicle delays. A crew arrived on scene before me and by the time I pulled up, they were bringing the girl upstairs from a club.

She had fallen onto a wine glass which had shattered, slicing deep into her neck and severing several main veins. Blood was gushing from her throat and it took enormous, persistent pressure to keep it under control. I went through four or five large, thick dressings trying to stem it but the wound was so serious that she began to slip away in front of us.

As soon as fluids were put up and everyone knew their place, we rushed to Resus with her. Her blood pressure had started to fall and she was perilously close to death. Blood stained every part of her clothing, even through to her underwear and pools of it gathered on her chest.

In Resus, she was given blood infusions and the frantic efforts to stop the bleeding continued. They were still ongoing when I left. I wouldn’t know until the next night what had become of this young woman.


A drunken 35 year-old woman demanded to know where her shoes were as the crew took her aboard the good ship NHS. At first she’d been uncooperative but had relented and allowed herself to be ‘treated’ for her excess. She’s probably a mum with two proud kids somewhere.


This call was followed another of the same ilk; a 40 year-old woman lay on the pavement, surrounded by police and PCSO’s... and a man she just met tonight, declaring that she was ‘hypo’. At first I believed her and checked her BM but it was normal at 5.7. ‘That’s low for me’, she said. ‘I’m not diabetic, I’m hypoglycaemic’, she then informs me, as if that’s a diagnosis of anything.

I decided she was drunk and being silly, so I left it to the ‘booze bus’ crew, who’d just arrived, to help her make her mind up. She didn’t like being told that she was a grown up, so she stormed off with her new boyfriend and took a taxi home (I guess).


Burping associated with chest pain and/or shortness of breath may be indicative of a heart attack. Unfortunately, there appears to be little material out there to confirm this but there are many, many personal reports. In fact, we are taught that burping is a significant sign and my next patient, a 54 year-old man who told me that he’d started burping ‘out of the blue’ after experiencing bouts of SOB for the past 24 hours and who now had chest pain, was a classic example.

Following the rule of ‘it’s only gas’ would have been potentially fatal for him but luckily myself and the crew that attended with me are switched on about this sign and his ECG confirmed an ongoing anterior MI. His heart attack was progressing so we quickly took him to hospital and straight to the Cardiac Cath Lab, where he got immediate life-saving treatment. He’d live to walk his dog again.


At a hostel in north London, a 34 year-old man walked down stairs and out to the ambulance, passing me and the crew as we made our way up to him after a call for ‘coughing up blood’. The alcoholic was even carrying a glass of beer and began sipping at it as he sat in the chair awaiting treatment. I absolutely hate the way people like this, who have ruined their lives through excess and stupidity, make us look like professional servants – they pay no taxes and generally give nothing back to society. They cost us dearly and often abuse their rights and privileges. Only those that have returned to society after having made a mistake with their lives get any respect from me because we can all end up where they were but those who choose that path and stay on it, while they get pampered and provided for, are nonsense to us all. This is your opportunity to tell me how bad that reasoning is and how we should all be glad to chip in to help them, even when they drink booze in the back of an ambulance, vomit and spit on us for the love of it.


The drink was taken away and poured out into the gutter. He wasn’t coughing up blood, he was just coughing.


An ashamed 21 year-old, caught drunk in a club and who was now too out of it to keep her eyes open, lay on a sofa as her boyfriend explained that she was ‘always like this when drinking’. The police arrived because a call had been made to them about drug use (she’d taken something with her booze) and she suddenly woke up and became semi-sensible. The cops weren’t interested and they left soon after, so I walked her to the ambulance when the crew arrived as she held on to my arm and told me how bad she felt. ‘I’m so, sorry. I’m so ashamed of myself’, she repeated.

Her boyfriend chipped in several more times about her state (for my benefit) and she showed him how much she loved him. ‘F**k off, George!’ she spat. How could such a nasty phrase come out of such a pretty mouth?

Be safe.

Young, gay and dead

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

Stats: 1 Cardiac arrest; 1 Abdo pain; 1 Back pain; 1 Head injury; 1 EP Fit.


First call of the day and it’s for a 29 year-old man who is lying on the floor of his male partner’s flat. He was found like this a few minutes ago – he’s in cardiac arrest as the result of alcohol and drugs (GHB and Crystal Meths). For some in the gay community this is a lifestyle and it’s simply not worth it.

My MRU colleague is on scene with me and we begin resuscitative efforts; the patient is still warm and pink but he’s a fit, young man, so there’s no reason to believe this is an indication of potential for recovery. His jaw is almost locked and it takes a lot of strength for me to get a Laryngeal Mask Airway in there. Intubation is not an option – it’s been tried by the MRU medic and it’s failed because of the stiff jaw.

A crew arrives after five or so minutes and we continue with CPR, drugs and no shocks – he’s been asystolic from the start and there is little hope of that changing, so we do what we can and look at the bleakest future for our attempt.

We take him to hospital, continuing his care all the way but they call it after a further ten minutes in Resus. So, before breakfast, I watched another young life disappear for no good reason; it’s depressing and makes me wonder what kind of day this is shaping up to be.


Abdo pain and groin pain next. A 43 year-old man, working as a labourer at a building site has collapsed and there is a protrusion in his lower abdomen. He may have a hernia.

The pain is only relieved with morphine – he refuses entonox and I find this to be quite common in people with abdo pain – just sucking on the mouthpiece causes further discomfort, so they tend to abandon it. I take him in the car because he is walking and talking and there isn’t an ambulance handy at the moment.


A 52 year-old woman is complaining of lumbar back pain at work. She walks to the car with me and tries entonox en route as her friend sits in the back with her. After a minute of travelling, she complains even more loudly about her pain and tells me that the entonox is ‘no use at all’, so I stop and give her IV morphine in the street. As I pack up ready to leave, a street sweeper happens by and delicately removes my debris (packaging and syringes) for me. Then we continue to A&E, where my patient’s condition continues to aggravate her despite the drug. She waits a long time before being booked in and clings to her friend as the pain beats her down relentlessly.


My MRU colleague was already on scene with a 68 year-old female who’d fallen down steps and banged her head. She had minor head and facial injuries; nothing life-threatening but enough to warrant a check up at hospital, so I obliged with transport and continued care. Her friend was with her – they were out on a jolly in London and I helped to create friction by remarking that she had spoiled it for everyone. It was all taken in good humour. Thankfully, I don’t come across too many dour patients and when I do, I don’t bother with quips to lighten the situation. I won’t waste energy.


Finally, an epileptic patient who had a 5 minute fit was recovering and post ictal when I arrived. She, like most of my patients during the day, was at work when she collapsed. She was very confused and had a bruised cheek for her troubles.

A crew arrived after I’d managed to get no sense out of her during my ten minute chat and by the time she was walked to the ambulance her memory was returning.


I start my nights soon... four of them to contend with. I apologise in advance if my posts become a little depressed as they progress.

Be safe.

Funny things can happen

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

Stats: 2 Abdo pain; 1 Unwell.


Off to a train station, with an ambulance coming up behind me (rendering me pointless) and I went with the crew to a collapsed 25 year-old female suffering from abdo pain. She has Crohns disease, so her pain is genuine enough. She has a slightly irregular ECG, so needs to have that looked at. But she also has a nasty bruise on her arm, given to her by an ex-boyfriend (nice). She tells us she has found someone who cares for her now and that he is gentle and kind. This is good because she is a nice young woman and doesn’t need a bully in her life. The story is made all the more relevant when she reveals that her new boyfriend is Scottish. Of course he is :-)

A 65 year-old woman took the bus from Swindon and arrived in London with her husband, only to step off and collapse feeling very unwell. She was as pale as a sheet when I got to her and she told me that she felt nauseous. She has no medical history and usually travels well, so when the crew arrived she was taken to hospital.

On the way to this call I travelled the shortest route, down the Mall and around Buckingham Palace. Unfortunately my timing was rubbish and they were changing the guard, with all the pomp and ceremony that goes with that, for the benefit of the tourists. My first hint that I wasn’t welcome with my fast yellow car, blue lights and sirens, was the annoyed looking police officer who was frantically re-directing me to avoid the horses that were heading my way. Oops!


Calls for ‘collapsed, trapped behind locked doors’ have given me corpses, genuine illnesses and trauma... and a few laughs. This one, near my station, for a 35 year-old female whose friend had been trying to contact her all morning after she’d said she felt ‘depressed’, descended into farce. The police were on scene and the woman’s friend was telling them how she was an alcoholic and could be so dead-to-the-world asleep that she wouldn’t hear the door being hammered. Or she could have done something to herself because of the conversation she'd had earlier with her. The cops were using their sticks to beat the living daylights out of her door before going round to the windows and trying the same. To sleep through that you’d have to be dead or deaf. I stood there wondering which one I’d be dealing with.

After a while of debating what to do and getting nothing from within, the police decided to break the door down. Just as the officer’s boot raised for the heroic one-thump ‘no key required’ access to the flat, a shrill voice cried out ‘What the hell’s going on?’

The tenant had returned from shopping (or drinking, who knows?) and she wasn’t pleased. She was visibly shocked that we were outside her door. She didn’t know whether she was going to be arrested or defibrillated. Ahhh, funny moments.


Finally, a 38 year-old woman with acute severe abdominal pain rolled around on the floor of her workplace Occupational Health Department. She gripped my arm and hugged me to the floor with her as her agony increased. She had real pain and needed morphine for it.

No ambulance was available so I resolved not to let her lie there like that but to deal with her pain and get her to hospital in the car – I know I’ll be frowned upon for it but duty of care means just that.

I gave the lady a decent dose of Morphine and by the time she was wheeled out to the car (they had wheelchairs and doctors in there but no analgesia) and placed into the back seat, she was positively grinning away to herself. She had gone to the land of Lah Lah, where at least the pain wouldn’t follow and I could manage her safely.

‘Are you okay?’ I asked before we set off. I needed to ensure she was conscious and alert, otherwise I’d give her the great antidote Narcan and she’d be back to her painful self.

‘Oh, yes’, she beamed, not caring a jot for anything but her current euphoric state.

When I’d been wheeling her out of the building, the lift had arrived and several young women were asked to leave it so that I could get in. The security guy was with me and he was going to show me out. But the lift doors had a mind of their own and they closed as the security man went in. I could see him frantically pushing at the buttons to stop the thing from leaving me stranded with the very people we had already emptied out of it. He failed and the lift went down. My patient and I stood there like idiots, smiling at the women who’d also been adopted for this floor unnecessarily (of course my patient was smiling at anything and anyone).

When the lift arrived again, I went down but found myself at the ground floor with no security man. He’d gone back upstairs to find me! I waited with my grinning patient until he finally appeared again (in the same lift) and showed me out.

When my job becomes a comedy of little errors, I don’t mind. My day is somehow brightened up by the humanness of it and I can go home content, which is all I want really.

Be safe.

Naughty footwear

Day shift: Six calls; one cancelled on scene; one treated on scene; three by car and one by ambulance.

Stats: 1 Unwell person; 2 Abdo pain; 1 ? Swine flu; 1 Foot injury.


A 47 year-old vomiting woman with a headache and abdo pain worried me a bit when she called after presenting with sudden onset symptoms after a few days trying to beat back her head pain. I’ve seen SAH develop like this, especially in females of her age, so I wasn’t about to rule out anything significant immediately. She had no past medical history and was normally well. She may have had a simple viral infection or she may be in trouble, so as soon as she got to hospital they took her to Resus but I saw her later on in a cubicle and she seemed over the worst. The morphine I’d given her for the pain and the metoclopramide to stop her being sick seemed to have done the trick. I hope she’s fine now.


A call from a 33 year-old woman who had ‘menstrual dizziness’ seemed nonsense to me but I trundled over to where she worked and found her to be well enough to travel in the car (of course she was). The Portuguese woman held her head, moaned to herself and kept up a long telephone conversation at the same time as I drove her to hospital. She could have taken a cab or walked there – she had waited quite a while with a CRU paramedic tending to her before I arrived. I was only assigned because it wasn’t deemed serious enough for an immediate ambulance. That at least was accurate.

Then, miracle of miracles, she seemed right as rain when she arrived in A&E.


Abdo pain can cause a lot of discomfort; sometimes so much so that a person loses consciousness, depending on upbringing, DNA profile and pain threshold I guess. Of course, there are physical reasons for passing out but most of the abdo pain calls we attend are not serious at all and require no further treatment than obs and time to recover. So, the 23 year-old woman who called an ambulance (or had it called for her) from work and was now laying on the office floor ‘fainting’ apparently, was ‘tagged and bagged’ with normal obs and no hint of a life-threatening illness as she went to hospital with me in the car.


My first possible Swine Flu case next and it happened to be a Traffic Warden. He was on duty and had probably ticketed many victims before folding up with back ache...in fact he was ‘aching all over’. His supervisors were with him and they’d insisted on a 999 call, even though this guy was fit looking and had no previous history of illness. He wouldn’t even stand up for me when I got there; preferring instead to keep the drama going while being watched by his superiors. I know this game well, I’m afraid – you have to be really ill before you can get a day off work, so even if you are a bit under the weather, or perhaps taking on a few symptoms of Flu, it is important that you act out the agony of a recently shot soldier in order to get the necessary nods of approval as you are wheeled off in an emergency vehicle.

The agony didn’t stop him getting into my car, mask firmly stuck on his viral face, and seemingly improving when he got to hospital. The nurses took one look at his uniform and their eyes rolled to heaven. He may well have contracted Piggy Flu but he should have gone home or been taken in by car – they could have ‘impounded’ a naughty motorist’s vehicle, you know, one that was parked deviously outside a shop on a single yellow line, then transported their friend and colleague to A&E reception, where all the masks are worn with pride.


A call that was cancelled for me as I approached the scene made me smile a little. A 30 year-old female who’d complained of neck pain and had spent some time with a CRU before I turned up (and went to the wrong entrance), walked herself onto the back of the ambulance before the crew had even got a chance to pull on the handbrake. Priceless.


There is a particular type of shoe worn by children that is a potentially serious hazard for their feet and I have to warn you about them here and now. My last call, to a 5 year-old girl whose foot had become caught in an escalator at an underground station, rang a bell because I have been called to several such incidents over the past two years, only in summer, where children’s feet have been caught, pulled in and mangled by the teeth of the steps as they close off. The problem isn’t the escalator, or the children...or their parents – it’s the shoe they are wearing. It’s always the same type of footwear; those plastic sandal style things with holes in them (I believe the holes are for little colourful bits to be stuck in).

This little girl had a minor graze on her foot but her shoe was torn apart and had been dragged right inside the gnashing mechanism of the step as it slid down inside itself. Her foot would have been ripped apart too, if it wasn’t for the quick-thinking of her mum and a lot of luck. The last patient I dealt with had severely damaged toes as a result of this kind of accident.

The shoe is made of a material that gets pulled easily by anything touching it – the plastic seems to have an easy-to-grip surface, so the metal teeth of the escalator only need to make light contact with the toe area and the whole shoe will be pulled in, foot included.

Luckily, the girl was fine. ‘I don’t need to go!’ she said as I arrived on scene in the little control room. She and her mum were in good spirits about it but I asked mum to write to the manufacturer and point out the problem. A warning should be sent out; otherwise a child is going to lose his or her foot.

I laughed and chatted with this cheeky little Irish girl as her mum reassured her and I dressed the wound. She didn’t need to go to hospital and I didn’t want to upset her more, so she was left with mum to go shopping – for new shoes. Any excuse.

Be safe.

The first aid conundrum

After looking at a few of the responses I've had after remarking on the weakness of qualified first aiders in their capacity to do anything of any value, I've decided to run the debate as a post, instead of responding to comments.

You may or may not know (or have any interest in it) but I've been teaching qualified first aiders for more than fifteen years and run a fairly successful little company, training people all over the UK. I consider myself an expert on the subject and fully understand the legal capacity in which workplace first aiders are supposed to operate.

Unfortunately, a lot employers dont give a toss about this and only train their employees because they have to. They dont care that the training they receive may be inadequate, amateur or dangerous and they dont care whether those chosen to do the training actually make any difference to the work environment. Of course, many other employers dont even bother with any training because the Health & Safety Executive (HSE), which is the legal governing body in this country, has no teeth and very little time or manpower to seek out and punish them. You have a much, much higher chance of getting caught without a TV licence than without a properly trained person who can potentially save the life of a colleague.

Ive been teaching to a high standard all of my career and simply wont drop them; this has cost me a few contracts, I can tell you. Some of the biggest companies out there are so hell bent on not allowing their employees to have the responsibility and power that goes with their qualification, that they obstruct any attempt to teach the rule of law. This goes on in some schools too - the first aiders are frequently over-ruled by their superiors and one school in particular just would not have me telling them that storing prescription-only medicines on site when the children weren't there was potentially illegal (look at the medicines act) - it seems some people just don't want the facts.

My company teaches in around 100 schools a year. The market is dominated by the voluntray services, particularly The Red Cross and the St. Johns Ambulance (SJA) and I've come across some incredible pieces of advice given to those in charge of our little ones; 'dont put a plaster on a cut', for example - almost as if that is illegal. It's not and never has been. There never, ever was a rule against it. Also, the 'don't take a splinter out of a child's finger' (or any part of them presumably) because that's an assualt, based on the premise that it is an invasive procedure! Think about it, these people (teachers and school staff) are in loco parentis; they can do whatever a reasonable parent might do and I'm pretty damned sure a reasonable parent would remove a splinter and not bother calling 999 or taking the child to A&E!

I'm not having a dig at one organisation or another and I'm sure that as I found my feet in training all those years ago, I wasn't perfect BUT this is ludicrous.

Schools are now being told that they must only accept training from OFSTED's approved list - ironic because the HSE is responsible for approving companies, nobody else. However, they want to regulate the paediatric side of training (not covered by HSE - yet) and this has led, in my opinion, to the downfall of a legal requirement that ensures they have adequate first aid cover for staff. A school that wishes to comply and get a good OFSTED report will need to send their people out to do a 2 day (twelve hour) course. The cost of this is astronomical (around £50 to £100 per head) and the value of what they actually learn and retain is debatable. Even people with a full 4 day's training and who are 'qualified' can turn out to be inadequate when it comes to the crunch, simply because of the quality of their lessons, the information (such as the drivel I highlighted above) given and the poor retention of skills and knowledge over the 3 years that they must have them (no practise, you see). It appears that many training organisations are so busy telling first aiders what they can't do that the whole point of them being trained at all rides off into the mist.

All of this may mean nothing to you but it makes our jobs difficult sometimes, as you know from my recent posts, and it smacks of someone, somewhere making millions for a low standard of training - in schools and elsewhere.

A qualified first aider is legally responsible for the emergency care of colleagues in the workplace. He or she must carry out their skills responsibly and with a degree of competency in order to potentially save a life and prevent loss of earnings (for employer and employee) through unnecessary sickness. This isn't happening and across the country you will see glaring examples of ignorance and apathy. Companies who have no first aider on duty are breaking the law and some of the biggest culprits are the biggest companies. If you have an accident in one of their premises and find this out, sue the arse off them, they deserve the punishment for their complacency (legally they dont have to take care of visitors to their site but they still have a duty of care, so they will settle out of court through fear).

First aiders who sat through their course yawning and whining about how hard it was, should not be doing the job. They had a choice not to be on the course in the first place; they just didn't know it because their boss bullied them into doing it.

If you are a qualified first aider in the workplace, get your act together if you haven't already because you will get caught out and it will be someone's father, mother, sister or brother who pays the price for your reluctance to practise and take seriously your role. Do a little reading up every month; pretend to resuscitate something - anything. Carry out the recovery position and get that damned elevation sling that you are useless at, right!

For those of you that know what you are doing (and I've met many of you), well done and be proud. First aid training is essential because it removes the fear and ignorance of taking care of others. Our ambulance services are in a mess because our kids know nothing of it and will simply pass the buck to a 999 call on the basis that they 'didn't know what else to do'.

In the public domain, there is no legal duty of care for you - its a matter of human principle to help people in trouble or get stuck in and do your best. You cannot be sued for trying to save someone unless you attempt to do it by methods that you are untrained in.

Whatever you feel about this subject, this is my personal opinion, but it is based on almost two decades of experience, learning and teaching.

I'm bored now.... your turn!

Xf

Roadkill

Night shift: Nine calls; all by ambulance.

Stats: 2 eTOH; 2 Abdo pain; 1 Emotional person; 1 Head injury; 1 Hyperventilation; 1 RTC with multiple casualties; 1 SOB.


The last of my run of nights and an interesting one to end with (although tragic also).


Of course it all starts with the obligatory drunk, which is given as a cardiac arrest, making me rush 3 miles in the hope of saving a life. I stopped at what I thought was the location of the call when I saw an ambulance parked up. I get out, chat to the crew and am informed that this is not a cardiac arrest – it’s a collapse outside a pub. Tsk! I think… but then I’m told that the crew’s CAD number is not the same as mine, so I realise I’m actually not where I’m supposed to be!

Another half mile up the road and I land where the real ‘cardiac arrest’ is; there are two ambulances and a small crowd around someone on the ground. Fortunately and kind of predictably, the man being carted off on the trolley bed by the first crew on scene, is not dying or dead… he is also drunk. A cricket fan of an age where he really should know better, has crumpled to the pavement after having way too many drinks on top of the nail-biting excitement of a day’s cricket. If you are a cricket fan, you must forgive my sarcasm; I’ve never seen the attraction to be honest. Balls, bits of wood, impractical whites and lots of running and shouting.


Oh well, the next call, to a 38 year-old with abdo pain but who called it in as chest pain, reminded me that my night was just routine and that an over-the-top performance of pain, which I could predict was coming just by reading the person’s name before I got there, would settle me down. She lay on the sofa while her child staggered about in the front room. Only when I touched her to carry out obs did she refer to pain and even then her demonstration was weak and unconvincing. She may have had discomfort (I don’t know for sure of course) but she really needed to play the game properly in order for me to assess it; just telling me she had ‘too much pain’ or ‘pain all over’ or that her score was 10 out of 10, regardless of the fact that she had given birth and surely that was more painful, was not good enough.

Her husband/father (who knew?) stood and shouted at me because he too was fed up with her wailing and rolling around on cue but I wasn’t in the mood for verbal abuse and, as he translated my questions to her, I asked him, quite firmly, not to raise his voice at me. It was all very complicated for no reason.

In the end, as she was taken to the ambulance by a crew with the same resigned look on their faces as I had, the man apologised and we shook on the basis that neither one of us held any high regard for the woman’s display of agony when we both knew it was fake.


Then an emotional Brazilian cleaner (who spoke no English either) feigned a ‘collapse’ at work and I was summoned, with an unnecessary ambulance, to say ‘there, there’. She had problems at home and, much as I would love to sympathise, we can all have those, so I asked the first aider on scene why he thought it was an emergency and he sheepishly admitted that his hands were tied by the possibility of litigation if he got this wrong. A fair comment but, once again, why bother with the training and qualification of First Aid at Work when you can’t use the responsibility and decision-making power that is given with it?


An ambulance was arriving on scene as I pulled up to rescue a drunken 37 year-old woman who had fallen and ‘couldn’t walk’. Worried MOPs had dialled 999 of course.


The next call, given as asthma, was a 27 year-old man who was hyperventilating. The crew was on scene and my trip had been pointless. I wandered down to A&E after that and visited for a while. Outside the doors sat a crying woman with a cigarette in her hand. She was an alcoholic with blackened fingers and yellow teeth and, as she sat there sobbing into her ciggie, I felt she epitomised the world within that department perfectly. In fact, she could have been the advertisement for it; a modern day figurehead for the NHS.


Further out in the north, a diminutive Chinese man lies on the ground in a little car park with MOPS who need to worry about him because he’s there. The man is so drunk it is difficult to keep him awake even when I get a response – he vomits so close to my boots I’m thinking about a career change and then he’s scraped up by the crew when they arrive.


The big job of the night is a multi-casualty RTC in which a moped rider and his pillion passenger (only one of which has a helmet on) crash at high speed into the back of a car as they jolly about in the crowded clubland area of East London. The front wheel comes off their ride and they are propelled, still on the bike, across a pedestrian area, hitting two people as they travel. The bike comes to rest under a taxi and both men are lodged there too. One of them is in a critical state when I arrive and a crew is working on him, so I am left to work out what is wrong with the other guy, who seems oblivious to the fact that he has been involved in a pretty terrible mess. A woman claws and paws at him as if she’s known him all her life but she is just a MOP who’s drunk and a little bit stupid because she’s ankle deep in petrol from the crippled bike and wont leave the man alone, even though I raise my voice several times and tell her to go away.

‘But he’s hurt, I need to be with him’, she wails without conviction or any territorial right.

I get a police officer to divide her from the injured man as I assess his condition. The only diagnosis I can come to is ‘drunk’ and he tells me he is ‘okay’ over and over again. He’s wedged under the taxi and obstructing the work being done on his erstwhile mate, whose condition continues to deteriorate. Keeping the badly injured man's head in place is a nightmare (this was being done by an observer) because space is very limited and my patient insists on trying to get up and walk off.

The third patient (one of the pedestrians) has a minor head injury and is left sitting against a post until more help arrives. The fourth casualty never makes an appearance and I only know he or she existed because I was told – walking wounded that walked off probably.

The critical man’s breathing is becoming laboured and slow and his level of consciousness drops dramatically until his eyes roll in his head and he begins to leave the land of the living. It’s not looking good. He has multiple serious leg injuries, some of which are so obvious they make you cringe just looking at them – totalled knee-caps are not a pretty sight for anyone.

HEMS arrive on scene after the man is taken into the ambulance – they are redirected as they descend on my patient. I have a crew with me now and we are trying to plan the move for him. I’ve checked him as much as possible but I’ve missed something. As we move him onto the scoop, I feel his lower leg bend unnaturally just above the ankle. He has a fractured tib and fib and his leg has become a jelly down there. Directions to straighten his leg are quickly cancelled as I realise just what the damage is and what it will become if he continues to obey and flex the muscles. He can’t feel a thing because he’s too drunk to know better.

Eventually he too is packed away in an ambulance and I return to the dying man at the roadside. The HEMS doctors are working away and I become part of the team until he goes to hospital. His chest is drained on the spot but he continues to slide into Neverland. So much damage has been done that when he gets to hospital, he’s in cardiac arrest and the only way they can hope to save him is by opening his chest cavity and trying to reach the bleeding artery within. Its all done there and then on the trolley bed in Resus – its brutal and a last ditch attempt… and it fails.

The accident scene was dangerous because of the people around and that large pool of petrol; a spark from any source would have sent us up in flames. The stink of the fuel sticks to me for the rest of the shift. I looked around as we prepared to leave it and all I could see was the debris of misadventure spread all over the road and pavement area – this was a lethal smash and getting out alive would have been a slim possibility anyway.


Back in reality, a 63 year-old man claiming abdo pain after telling the 9’s calltaker he had shortness of breath, got himself an ambulance and little sympathy from anyone, especially the hostel manager. He does this all the time apparently; claims life-threatening illnesses to get an ambulance and then reports nothing more than abdo pain. I travelled 4 miles to hear him tell me this.


No patient contact on the last call to a 23 year-old woman claiming ‘heavy breathing’. I was unable to find the address so left it with the crew when they arrived. Maybe she was making a phone call.


The night’s big job had drained me, so I was glad to be shot of it and go home. Tragic as it was, the event was self-inflicted and nobody can stop the stupidity of those who wish to take risks with their lives and lose. The toll on us, however, is stress and the frustration that we can’t do anything to help. The teamwork was amazing and the officer that turned up to help was very supportive – he didn’t get in the way, he just let us do our jobs. My patient ended up on the critical list himself – he had other injuries that could not be seen. He was far too drunk to be assessed properly and far too drunk to be riding a bicycle, never mind a motorised one.

Be safe.

Risks

Night shift: Five calls; one assisted-only, one conveyed and three by ambulance.

Stats: 1 Faint; 1 Assault; 1 DIB; 1 Head injury; 1 Asleep.


Another night during which I supervised the progression of the SP with me.


The faint occurred at a very nice hotel in Mayfair (aren’t they all in that area?). The 27 year-old woman member of staff has a history of low BP and this is probably what caused her collapse, so she was left with her colleagues and sent home by taxi. While the SP carried out the last of the obs and did the paperwork I found myself at a loose end and so I asked about the penthouse suite and was told that it went for £7,500 per night and that a couple of rich guests had actually been fighting over who would get it. You know you’ve made it in life when all you have to argue about is the possibility of getting into a suite that costs more for a night than most of us can earn in months.


A call to a small street in the West End next, for a man with chest pain and a young woman who’d been assaulted when a fight broke out in the street and spilled into a shop. Actually, it wasn’t a fight; by all accounts, the girl’s boyfriend had been set upon by a gang of youths as he innocently talked on his mobile outside the premises. The thugs had deliberately provoked him by pushing him as they passed. He spoke up for himself and was beaten up for his trouble. Now, I have the same nature so I understand this. If I get pushed like that, to provoke me, then I’m afraid I will throw this biblical ‘turn the other cheek’ thing on its head and retaliate. The problem, however, is that you can end up being overwhelmed by feet and fists or even stabbed to death these days, so the risk seems disproportionate to the pride issue. Nevertheless, I still understand this young man’s need to defend himself.

The fight started in the street and crashed through the glass door of the little shop, where we found the owner suffering chest pain, probably as the result of the high stress he’d experienced. He was given priority for treatment when the ambulance arrived.

The girl had a cut foot and had been pushed violently against a large fridge when one the gang’s girlfriends decided to make an appearance and chip in. Gang-forced violence is ugly enough but when the women get involved on the back of their male counterparts’ testosterone, it’s even uglier.

The SP dealt with both patients, so she gained experience in mini-triage and multiple casualty situations (even small-scale is good practise). Then her boyfriend appeared out of the back of a police car (they’d been taking him around the area to try and identify his assailants). She hadn’t known where he was and a little concern crept in as we started to think about why he’d disappeared suddenly. The thought of him lying in some side street with a stab wound occurred and so it was a relief when he showed up. Now the SP had another patient to deal with.

We took both of them to hospital in the car; they had minor cuts and bruises, so it was safe to go that way. There were no ambulances to spare anyway.


Anyone with a history of DVT presenting with shortness of breath should go to hospital and so the 32 year-old woman who called us for DIB was taken from her hostel by ambulance after we’d started the obs and listened to her story of increasingly difficult breathing. It would have been easy to dismiss because she seemed fine and her breathing was good but, as I said, the history gives rise to caution here.

Outside, as I sat in the car waiting for the SP to complete her paperwork in the back of the ambulance (and being keen to do her best, she also wanted to continue her care of the patient and see the ECG), the rain was coming down in sheets – hard and violent, bouncing off the street as it landed. I watched this in the dimming light of the evening and, as if by some design of irony, an aboriginal woman appeared around the corner and walked past me. She was no more than 5 feet tall and had no umbrella. It would have been strange enough on a calm night but there she was, walking in this awful rain and completely out of place. I notice these little things and they click and whirr in my brain as if they are important sometimes.


We spent over an hour at an underground station late at night tending to a very drunk man who’d fallen quite a distance down the escalators, sustaining a head injury which was mostly facial. His cheek and nose were fractured and his eye socket was swelling and darkening. He kept trying to slip into unconsciousness and there were no ambulances at all for him; all he had was me, the SP, underground staff (who did an outstanding job) and two British Transport Police officers, one of whom became my drip stand.

The fluids kept the man awake and he giggled and apologised his way through the time we were with him. I could do nothing else but monitor him and we’d carried out constant obs to ensure that he didn’t deteriorate unnecessarily. At one point he coughed blood into my face and I got some of that in my eyes and mouth – there was an uncomfortable silence as I, and everyone around, waited for the result of my temporary shock-freeze. I was handed an antiseptic wipe and that was enough to clear the worries from my face. It’s happened before and it’ll happen again and he didn’t mean it. I have a good immune system, so I’ll trust it.

The crew arrived and we got on with the job of collaring him, boarding and moving him all the way to the top of the escalators and out to the ambulance. He was still conscious but we had no idea what was happening inside his head, so he was ‘blued’ in.


The last call of the shift took us to Park Lane for an ‘unconscious’ woman who was lying in the street in the early hours of the morning. The caller stated that he had to go to work so couldn’t stop and check to see if she was alright. What happened to chivalry and the care of others?

We arrived to find her sleeping on the pavement, with her handbag and purse out for all to see (and steal if they wanted to). Her trousers were unzipped (not sure why) and she sat bolt upright as we approached her. Within seconds she was wide awake and worrying about being dragged to hospital. That was never going to happen – she was a 25 year-old woman who’d got drunk and fallen asleep outside near a main road. She didn’t need us and no obs were necessary; the SP ensured she got safely into a taxi to go home. She wasn’t ill, she was vulnerable.

Be safe.