The kindness of strangers

A lucky escape.

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

Stats: 1 ? #Leg; 1 Arm injury; 1 ? Spleen; 1 eTOH; 1 French person


On my own again for a few shifts.

I drove at 1mph trying to reach a RTC that had taken place a mile up the road I was travelling on. That’s the trouble with some of these road accidents; they can cause such a tailback of traffic, especially in rush hour, that even the emergency services have trouble getting to them.

An ambulance was fighting its way through the same mess that I was but we both arrived at the same time at the scene of a lorry vs lorry vs car RTC. The first lorry had ploughed into the back of the second at 30mph. The second lorry was stationary when hit and was shunted off his brakes into a small car carrying a mother and her two young kids. Luckily nobody was badly hurt and all we had to concern ourselves with was the passenger of truck number two because he’d bashed his head on the dashboard and, more significantly, the driver of truck number one, who was trapped by his left leg because the entire front section of his vehicle had come into the driver’s cab, pinning him.

It took a long time for the LFB to pull away the dash and steering wheel so that the driver could be freed – they had to work very carefully, as always, so that they didn’t inadvertently injure the patient. Meanwhile another two ambulances were requested to take away the head injury and the kids (just to be sure). I considered HEMS because the lorry driver’s injured leg had been squashed against his seat for some time now – going on an hour – and I was concerned about crush syndrome. But the leg didn't look too badly pinned and once he was freed, another, more thorough, physical examination ruled out any immediate threat.

I gave him morphine for his pain and we immobilised him for good measure. He’d been very lucky and if he’d had a passenger, he’d have been trapped next to a corpse.


Next, a 68 year-old lady from New York was hit by a speeding motorcyclist as she stepped from the pavement. Police were on scene and she was sitting in a shoe shop insisting that she was okay. She was a feisty 'New Yoiker' type and didn’t look her age at all – it was given as 50 by the system and I believed it.

She wanted to get on with her day and visit the theatre and my advice to go to hospital for a proper examination of her arm, which was swollen and bruised after the hit, was met with mild resistance. Due to fly home the next day, she clearly didn’t want her day to be spoiled by a mere broken arm (if she had one), so I agreed to take her to the local minor injuries centre for assessment. She was happy to do this and invited me to join her at the theatre later on (she’d also offered to take the female police officer who’d been dealing with her back to New York – for her son). I declined her generous offer on the basis that I was too bury with my shift, otherwise I might have been tempted.

This was a pleasant lady with friends in high places (judging by the names she quoted when phoning around) and she was sensible enough to know that her injury may or may not be significant enough for hospital but that she’d take responsibility for herself.

She was deemed fit to carry on (the nurse and I came to an agreement) and so I drove her to the street she’d had her accident in, where she could get to the theatre on time and without fuss. She got the best treatment the NHS could offer and I got a peck on the cheek as a thank you.


Ironically and coincidentally I had been asked by my last patient if accidents like hers occurred regularly on that particular street. I confirmed that they did and, as if the point needed to be made, another call came in for yet another collision at the same spot. This time a pedestrian had been hit by a cyclist who’d run the red light. His handlebar had hit the 30 year-old woman at 20mph, punching into her left lower abdomen, exactly where her Spleen lies and this is what concerned me.

She was sitting on the pavement as police officers interviewed the cyclist and I was given a short handover by an A&E nurse who happened to be passing at the time of the incident. The patient had no significant pain, other than in her abdomen and there was some tenderness on palpation of the area, so I decided I would not be conveying this one in the car and asked for an ambulance. The Spleen is an organ that can be damaged without much in the way of visible changes in vital signs and so I wanted to play it safe with her.


I witnesses a demonstration of the frustration that real patients feel when they take themselves to hospital but don’t get seen because it’s too busy and priority appears to be given to those less worthy.

I had been called to a collapsed 40 year-old man and I found the police around a human lump with a blanket over him and a bottle of wine at his feet. He was drunk and had already been assessed as being so by a crew earlier on in the day. I knew that he was playing the winter game because it was cold today and he was dishevelled and shivering, so I asked him if he needed to go to hospital and got the expected response – an enthusiastic nod of the head. I agreed to take him in the car if an officer accompanied him because he had a record of hitting the police, so I would be fair game with my back to him as I drove, should he decide to kick off.

We arrived to a packed A&E and I apologised for what I’d brought in because it was clear they had bigger fish to fry but as a vulnerable drunken man who’d go on playing his game until a dozen ambulances had been called for him, I was left with little choice.

I sat him down on the seats in A&E and two women who had been waiting there (one of them had been crying), stood up and walked off. To be fair, he did stink of urine and I wouldn’t want to be unwell and in his proximity either. Then one of the women collapsed in pain and I had to steady her until other medical staff helped out. She had a serious headache and had been sitting waiting for attention for hours after having come by taxi and booked herself in. Now I understood the look of disgust she had given me as she stood up to walk away from my offensive friend. As far as she was concerned, a drunk would get higher priority than her. After all, he had arrived by ambulance. For all we knew that poor woman was suffering a serious condition (subarachnoids can present as severe headaches initially).

Meanwhile, out in reception, an impatient patient stormed out of the waiting area to complain about how long she’d been made to wait, only for her name to be called while she was away. She had to sit down again and wait for even longer. This annoyed her, so she got up and stormed off once again to complain. I walked into reception to hear her name being called again and the staff’s amazed reaction that she had missed her second chance at being seen. She might go on all day like that.


Calls can often be a little strange and my next (and last) call of the shift sent me east for a 26 man who had abdominal pain and a headache. He had collapsed in the street but two young ladies found him and taken him to their 5th floor flat in a nearby tower block. This strange action was carried out in the name of humanity and kindness I can assure you because when I got there, three young men and two young women were standing over a doubled-up Frenchman in their kitchen. He was like a sick stray cat, except, as I pointed out for their benefit, he wasn’t and they didn’t know what he might have been up to. He spoke very little English and my French is just about good enough to get by in an emergency, so they didn’t even know what his background was.

I found, through fumbled broken Francais, that he had broken up with his family in France and had run away to London, where he’d spent two days on the streets, penniless. His abdo pain and headache may have been real enough but I think his underlying problem was being lonely in a strange city.

I took him to hospital in the car because he was another vulnerable case as far as I was concerned but I had to keep checking him in the mirror – he was behaving oddly and I had that ‘I’m not sure why but I’m not comfortable’ feeling with him. I imagined him reaching over with a huge knife or attempting to strangle me with my own seatbelt but this mild paranoia probably had more to do with my instinct and natural wariness of people who behave oddly than any actual threat, otherwise I would never have conveyed him, right?

A&E was packed and I had to wait a long time before I got to book him in. All the while, he sat in a seat, looking pain-free and watching everything and everyone around him as if he was expecting something. Maybe I’d behave the same way in a strange, foreign environment if I was alone and desperate.

Be safe.

Locked out

Day shift: One call (but technically two); All by car.

Stats: 1 Head injury; 1 Abdo pain.

I drove in this morning to lashing rain and lightning, which always looks more sinister in the very early hours I think. The weather changed late afternoon yesterday and it had been raining ever since. Less than half the people I would normally expect to see crowding the streets in Central London for the way-too-early pre-Christmas spendathon were out as a result. This meant I had a quiet start to the day.

The first call came in the afternoon and we were off to an ice rink to attend to a 3 year-old girl who’d fallen – not on the ice but on the walkway leading to the rink. She had a nasty bump and cut to her forehead but she was otherwise alive and well. Mum wasn’t too fazed but the first aiders on scene felt she needed an ambulance and called us. Then they completely ignored the fact that we’d need access to the area and we found ourselves outside locked gates with nobody to meet us and no idea where we were to go. This is fairly typical of large scale events when the staff is not properly co-ordinated.

We wasted ten minutes communicating back and forth with Control until somebody finally came to help and then I had to drive around for another quarter of a mile to get in. An inner security barrier was down when we got as far as throwing distance of the fair’s main entrance, so we waited for that to be raised but then I was told to park up and walk.

The SP went on ahead of me and I parked the car. Then I walked along a pedestrian avenue with funfair stands and attractions either side, including a giant singing moose-head that was chucking out-of-tune Christmas songs into the air at high volume while a woman stood directly underneath it attempting to use her mobile phone. The moose was the cleverer of the two I think.

Inside the rink, the SP was happily dealing with a very stable, quiet little girl with a bumped head. The girl’s mother was there and I decided they could go in the car rather than an ambulance. But a member of staff asked me to look at an employee who had abdo pain; the 23 year-old had left-sided pain which had started earlier in the morning although, typically, she hadn’t bothered to take anything for it, so now she was doubled up. I asked for another car to be sent for this patient because I had no room for the SP, the child, her mother, this abdo pain lady and her husband, so a colleague arrived a short time later to convey patient number two.

I managed to get the car all the way into the park and just outside the rink but only after I made it clear that I wasn’t happy with their access arrangements for the emergency services. These were minor first aid problems but if they had a real emergency they’d need to sort out their comms and gates.

Be safe.

Tricky situations

Day shift: Six calls; three by car; three by ambulance.

Stats: 1 Broken nose; 1 eTOH fit; 1 Gas inhalation; 1 Back pain; 1 Flu; 1 Fractured wrist and ? Neck.


On this mild November morning, a 25 year-old woman tripped over an uneven kerb and fell flat on her face, breaking her nose and bleeding all over the pavement. She sat alone, crying and leaking from her nostrils until an off-duty police officer saw her and stopped to help. I think she was on her own for ten or twenty minutes.

I have my Student Paramedic (SP) on duty with me all weekend, so she attended as I watched. There was nothing we could do for the young woman except take her to hospital in the car as she sobbed into her phone, explaining to her friend what had happened. Her bleeding was under control but her nerves weren’t settled yet.


Alcoholics are prone to seizures and sometimes it’s obvious what’s happened to someone when you see their pallid, profusely sweating faces. Add a history of falling over suddenly and evidence of possible alcoholism in the form of a half bottle of vodka in their pocket and it’s a no-brainer.
This 30 year-old alcoholic had fallen over in seizure, smashing the back of his head on the glass part of the front door of a coffee shop. There was a large crack where his head had made contact. His fit had lasted a few seconds and he’d bitten his lip but he was over the worst and recovering in the company of two police officers when we arrived.

I wasn’t sure of the man’s honesty when he assured us that he’d behave in the car if we took him to hospital that way, instead of by ambulance because he was reluctant to go to either of the two hospitals that I serve. He must be getting thrown out of them and there’d be a good reason for that, so I asked the cops to do a background check on him and, sure enough he had a history of violence and other problematic things (like suicidal tendencies). He was calm and reasonable though, so the cops agreed to follow me down to the hospital if I took him in the car. I’m still not happy to make an ambulance crew convey a patient who could quite easily be taken in the back of the FRU, so that was that and the trip was uneventful.


After coffee and one of those messy but delicious chocolate swirl thingies, we were off to an 82 year-old man with a history of black outs who’d collapsed at home and triggered his Careline alarm. Another FRU was on scene and we all travelled the lift to the floor on which the elderly gentleman lived. The SP and the other FRU paramedic went into the flat and I followed a few seconds behind them. They were assisting the patient as he lay on the floor of his room but I immediately smelled gas and asked if the others did too. He had left his cooker ring on and for at least 20 minutes, gas had been escaping into the little flat. He also had heaters on and this meant the hazard was higher for all of us.

We evacuated him and I took the keys from the door and allowed it to close. A window had been left open to air the flat out but we asked for the LFB anyway, just in case because I suspected that an electrical heater was running in one of the rooms.

The FRU paramedic’s equipment was inside the flat when I closed the door and I was distracted by the fact that the patient collapsed and became unconscious on the landing just as the crew arrived to help. He recovered quickly on oxygen but I found that when the door had closed it locked on the Yale. The keys I had taken were the wrong ones and didn’t fit, so now all the equipment was locked inside. I’d taken quite a lungful of the gas and, although it shouldn’t do me any harm, it still made me feel dizzy for a while. So we were on the landing with a collapsing patient (his ECG showed a heart block), a paramedic’s gear locked behind a door and the prospect of something igniting the gas inside the flat.

The police showed up just before the Fire Brigade arrived and I went downstairs with the patient and crew to the ambulance. He was stable now but his breathing wasn’t great and there was an obvious retraction of his intercostals and diaphragm, so he was blued in.

The LFB made the flat safe before we left for hospital and the fuss died down around the building (residents were beginning to worry). My head cleared and we got on with it.


An unnecessary ambulance trip next for a 40 year-old man with a childish estimation of his age: ‘How old are you?’ ‘I’m 40 and a half’. He was lying face down on the floor of a police station where he’d presented himself after travelling from deepest south London. His only business with the police was to inform them that he had a sore back.

He had been drinking (a half bottle of vodka by his own admission) and his hands bore the tell-tale swollen knuckles that indicated a puncher (of things or of people), so I was wary of him. He moved into a sitting position after much persuasion and the crew took him, reluctantly on his feet and slowly, to the ambulance, where he became cured by distraction, as often happens with people who are drunk and have nothing else wrong with them. He would now tie up a hospital bed or waiting room chair until he is sober.


Oxford Street was pedestrian-busy as we weaved around the buses to get to our next port of call. Inside the large store, a 30 year-old member of staff lay on the floor of the Manager’s office, refusing to open her teary eyes and playing limp as if dying. I’ve seen this many, many times before and you know I just hate it when adults behave like that; with some certainty I can tell immediately that there is little wrong with them – not enough to warrant an emergency ambulance, that’s for sure.

The SP managed to get the patient to speak but of course, in time-honoured fashion for this behaviour, all verbal responses were whispered. Little voice patients believe that making inaudible sounds with their vocal chords is tantamount to establishing serious illness for the benefit of colleagues and anyone else near enough to actually hear them.

She had aches and pains (pain all over), a cough, dizziness and vomiting – she probably had ‘Flu and since all influenza these days is H1N1 Piggy-type, she was given a mask and we donned our own. The drama was too much for the staff and we found ourselves with some clearance as we made our way out of the place, with the patient in a wheelchair, via the back entrance.

We took her in the car and she ended up waiting, like everyone else with minor problems, suitably masked up, for a doctor to tell her what we already knew – she could go home and get over it naturally.


Finally, as darkness invaded the day and the rain spoiled everyone’s fun, we were sent to the 5th floor of a large store where a 30 year-old staff member had slipped on water and landed awkwardly on the hard toilet floor near the urinals he’d just visited. He was complaining of pain in his right wrist, which was probably broken at the Ulna, lower back pain and, more significantly, high spinal pain, at around C2, so he was going to be collared and boarded. Trouble was, there was no ambulance around and I had to call for one.

During the wait for the ambulance I gave the man morphine for his wrist pain (he couldn’t tolerate entonox) but his respirations suddenly dropped and he tried to go to sleep. I’d only given him a smallish amount but I was forced to reverse it all by giving him Narcan in small doses until he came back to normal (or as normal as possible).

Now that he was stable and feeling the same pain as he had originally, thanks to the lack of analgesia (next time I will give Oromorph), the crew arrived and together we got him onto a stretcher and took him down in the freight elevator (the only one big enough for the stretcher and all of us) to the ambulance.

This was blued in once I was sure his breathing was better and his trip to hospital lasted five minutes. The entire job, from start to finish, took almost 2 hours. And I got home late. Never mind.

Be safe.

Head cases

Night shift: Three calls; one treated on scene; two by ambulance.

Stats: 1 CVA; 2 Head injuries.


The last night shift and I’m glad of it. This is a quiet one, which makes up for the three nights before.

A call to an elderly man with a previous history of CVA first; he’s losing power in one arm but otherwise he’s stable, so I left the crew with it and made my way back across the river to a West End that had settled down somewhat compared to the previous nights. The revellers had clearly had enough.

It wasn’t until the early hours of the morning that I received my next call for a 28 year-old female who’d been assaulted during a fight at a club. She was being helped by the security people but it was clear from a distance that she wasn’t a happy person.

She had minor cuts to her mouth and scalp, some of which needed to be cleaned and dressed and I made a valiant effort to do just that when she went a bit mad, screaming at everyone and generally being abusive. ‘Where the f**k is that bitch!’ she yelled. I assumed she meant the person who’d done this damage to her. And try as the security did to calm her down, she wasn’t interested and stood up, pushing her way through him and me, almost knocking me off balance. She didn’t care and made that clear as she tore the perfectly bound dressing from her head, throwing it to the floor.

I accepted her refusal because that's what it amounted to and I wasn’t in the mood to baby-sit a drunken outraged woman, so I told her I was leaving and made my way back out into the street, passing the two police officers who’d been brought in to interview her. She followed with a male friend and stormed past us all. Neither the cops or anyone else who’d been sent to help her were given any courtesy, so it all ended there. Sad and stupid.


A little more stupid was the passenger who allegedly threw a man from a bus because he didn’t have the patience to wait for him to produce his travel pass. The call was for a 25 year-old man who’d dialled 999 as he lay on the ground at the bus stop with blood pouring from his head after making hard contact with concrete as a result of this assault. The well-spoken patient was being attended to by police when I pulled up and he lay where he’d landed until I’d deemed it safe enough to move him into an upright position so that I could apply my second head dressing of the night. This time it wasn’t torn off but the man was very reluctant to go to hospital and the reason for this became clear as I progressed through my clinical interview with him.

More and more young Muslims are drinking alcohol these days and, with the strict upbringing they receive, when they get into trouble and the police and ambulance services are involved, the last thing they want advertised is the fact that they were drunk; if their parents find out, they risk more than a ticking off I understand. So, he didn’t want to be treated at hospital unless we promised him that it would all be confidential. And for the benefit of my readers I should let you know that treatment is entirely confidential unless you are unconscious or seriously injured and a next of kin has to be notified.

With this assurance, he went with the crew to A&E, where his wound could be cleaned and properly assessed.

As for the bus driver, I think he will find himself in trouble for driving off after one of his passengers carried out such an unprovoked and violent attack. The poor man was only having trouble getting to his pass but the delay was obviously too much for one person on board. The driver should have stopped the bus and contacted the police, unless there is a rule I know nothing about which states that they can leave the scene of a crime. The cops have the bus number and they know where it was headed; it will be stopped and if the assailant isn’t on board, the CCTV footage will be examined. The driver will have questions to answer I should think.

Be safe.

Ghost hospital

Night shift: Eight calls; two false alarms; one by car; the rest by ambulance.

Stats: 2 Head injuries; 1 ?PE; 1 ?Allergic reaction; 1 Sleeping non-fitter; 1 Homeless sleeper; 1 eTOH with fracture; 1 Abdo pain.

Radio communication is still leaving me in awkward and dangerous situations and being solo without a voice at the end of a call is beginning to look like a rotten option. My first call highlighted, once again, that our new all-bells-and-whistles radio system may not be as good as we are told because I found myself crouched down next to a semi-conscious man who’d sustained a head injury after hitting the ground hard, surrounded by drinkers from the pub outside which he’d come to grief, all denying that he’d been punched in the face when the evidence was clear that he had, and absolutely no reply to my repeated requests for assistance over the air. One of my MRU colleagues heard my open-channel request for the police and an ambulance and liaised on my behalf to get things organised as I attempted to keep control of an increasingly restless patient and a crowd of witnesses who ‘didn’t see anything’ in very close proximity to me as I worked to get obs.

The police arrived within few minutes as I put oxygen on and completed the minimal obs I could gain under the circumstances, then the MRU paramedic pulled up to add another pair of hands to the task.

I’d palpated the man’s neck and it felt like he had a step deformation (where the bone feels like it has sunken in) of his upper spine at the neck; this is not good and suggests a seriously hard landing on the ground when he fell, probably hitting the kerb with his neck. His mouth was bloodied and burst around the side (the first indication that I’d got of an assault and not a fall, as had been vehemently suggested) and he was slipping in and out of consciousness, although the alcohol he’d imbibed possibly had a lot to do with that.

HEMS was requested because the man needed to be calmed for the trip to hospital and his head injury would soon make him very difficult to manage safely, so the police threw a taped cordon around the scene and once the doctor arrived, the patient was RSI’d and rushed to Resus, with me ‘bagging’ him all the way there.

I'd find out later on that this man's condition was very serious indeed. He had multiple skull fractures with internal haemorrhaging to his brain and a broken neck.


A 23 year-old French girl fell down at work, complaining of leg pain, chest pain and feeling faint. She told me she had a history of ‘bad circulation’ in her legs and I thought that working as a waitress at a restaurant was possibly not a good move if this was the case. She may have been describing blood cots in her leg because the actual problem she suffered with was not clear. Certainly, and even in the absence of dyspnoea, there was reasonable cause to believe that she may have a PE and so I asked for an ambulance, rather than risk taking her in the car.


If we come to help your young child after you’ve called 999 and requested an emergency ambulance, please do not do the following; (1) expect us to assess him/her while he/she is still asleep in bed; (2) tell the paramedic who has just had to wake your potentially dying child up in order to do said assessment to ‘speak quietly’ so that he doesn’t wake your other child up (the one in the cot nearby) and (3) inform your child that the paramedic will be sticking a needle in you when he is about to do a BM test.

The parents had called us because mum thought her child was having an anaphylactic reaction in his sleep. The crew was arriving as I pulled up and we were led into a dark room in which two children slept peacefully. The boy in question had been breathing a little noisily so mum was concerned. He had a history of potential allergic reaction, so she was being careful and wanted us to check that he was okay but she didn’t want to wake him up and took issue with the volume at which I spoke to him when he was awake. She’d dialled 999 but was more concerned that I’d wake up the other sleeping child; it was a confusing paradox, so I suggested we take the boy into another room, where I could speak like a normal person and not a librarian.

‘What’s he allergic to’ I asked. ‘Horses’, mum replied. Bearing in mind we were in Central London and the nearest horse was probably rotating on a spit in the local kebab shop, I found it unlikely that her little cherub was reacting to one.

He was fine, except for a cough; there was no wheeze or swelling or rash or any other problem that I could determine – not that he was very good at co-operating; he wriggled and cried and was obviously too tired to be prodded about like this, so I decided a BM would be the last of my obs while I had the opportunity. Unfortunately mum decided it would be prudent to inform her little 4 year-old that I was about to stick a pin in him and, predictably he went a bit mad; writhing, screaming and generally making more fuss than it was worth. On this basis, I confirmed that he was well enough to stay home and abandoned the idea of taking a drop of blood from him. Mum seemed pleased. ‘It’s okay, she’d said to him, it’s just a little prick’. Yeah I thought... it is.


And then the local drunks had a laugh at our expense when a bus driver called in a ‘collapsed person’ that he’d seen fall down at a bus stop before driving off. What he had seen (and had generated a Red1 call) was a very drunk fool falling over. The guy was on his feet and swaying when I arrived. His grin and sheepish look made him the ideal culprit for someone who frightens citizens into doing the right thing. He stood with a black bin bag in his hand – it either contained his worldly goods or cans of extra strength lager (which amounts to the same thing). So, without actual proof and his denials ringing in my ear, this was a no-trace nonsense call.


A ‘fitting’ call in Oxford Street was nothing of the sort. The poor guy was trying to get his head down for the night in the doorway of a shop and had been rubbing his hands together to keep warm when two MOPs, one of which identified himself as a nurse ‘with a year’s training’ decided he was epileptic and having a seizure! So, when I arrived, the homeless man was understandably peeved and the ‘nurse’ continued to be concerned despite the fact that the man was very clearly not having a fit. ‘If I was having a fit, I would have told them’, he shouted illogically. The MOPs should have taken the hint but they didn’t and were keen to see me haul the man off for tests and such no doubt. ‘I’m being harassed now’, said the trying-to-sleep man.

After I’d politely sent the MOPs away, the homeless man told me that the ‘nurse’ had been feeling his leg and saying ‘come home with me’. Apparently one go wasn’t enough and the nurse-MOP had returned again and again after several objections from the man, allegedly to cop a feel and ask him back to his place. London just gets weirder and weirder.


On the second attempt at trying to put me on a rest break, I was called to attend a 75 year-old man who fell down a few steps at his apartment building and cracked his head on the floor. He’d been carrying a plastic bag containing two half bottles of whisky and these were now rattling about inside it, so his money and ambitions to get even more drunk than he already was, had evaporated.

Two of the tenants, returning from holiday, had come across him and his bleeding head as he lay around waiting for rescue. Luckily they had been returning from holiday at a rubbish hour of the morning and just happened to be entering the building at the right time to call for help. Otherwise he may well have been there til much later on in the day before being discovered.
His injury was minor – a cut or two to the top of his head and a slight bruise on his face but his age and the circumstances of his inebriated fall were worthy of a hospital trip.


As I sat on Trafalgar Square watching as workmen placed a bunch of strange trees onto platforms I got a call to a bus on the other side of the Square. There was an unconscious man on it apparently, shock horror. He was a tall, filthy, homeless chap with dreadlocked hair and huge laceless shoes. He was asleep and easily woken. Within 3 minutes he was off the bus. Then he crossed the road at a pace (he’d been limping as he left the bus) and boarded another bus going north. I watched him go upstairs, sit at the back (where he’d be invisible), pull his hood over his head and settle down for a sleep (part II). Somewhere in London later on an ambulance will be called just so that he can be ejected from the vehicle; he will bus-hop at the expense of the tax payer and genuinely ill people all night and probably every night.

Now, I wonder how he and his fellow bus-hopping homeless sleepers get aboard. Do they have bus passes? Doesn’t the driver recognise a potential problem when he or she sees it climb on? I’d really like to hear from bus drivers on this subject.

Of course, I complain about them but it’s the drunks on buses that annoy me, not so much the sleepers with nowhere else to go. I think I’d rather be called to wake them up than have them go to hospital to steal a warm bed and a free meal from a more deserving person (like someone who is unwell). In some respects they are playing the system where London Buses is concerned. If they are allowed on and can hide at the back without being bothered then they might get an hour to sleep at a time. Unfortunately, the bus people can’t manage this problem so we are called to deal with it and that is an abuse of the service. Street dwellers looking for a dry, warm place to sleep is nothing new and they will go anywhere that gives them an undisturbed kip – the buses are included, so why don’t the bus people fix their own problem? Maybe it’s best just to leave this status quo for the sake of the ‘they have to go somewhere’ argument or purely on humanitarian grounds but what if this costs someone their life?


This debate continues with a trip to a bus terminus to attend to an alcoholic whose been removed from a bus by the police. They think he needs to go to hospital and they are right because not only is he very cold (temp read ‘LO’) but he has a cast on his arm and from the appearance of his upper arm, just above the cast and sling, it looks to me as if he has broken his Humerus and dislocated his shoulder. This drunken man has fallen onto his already injured limb. So, I take him to hospital in the car and I walk into a ghost town – beds are empty and there is nothing going on. For the first time in a long time (as far as I can remember in fact) there are no ill or injured people around. Except of course for the one I’m bringing in. Judging by the reception I got you’d think I ruined someone’s birthday party. Even in the waiting area there was nobody waiting. This must mean that Londoners have drunk themselves to sleep or that alcohol has simply run out.

A local call to end the shift and a crew arrived behind me for the lady with abdominal pain who needed more advice than treatment. I left as the crew settled in to listening to her entire medical history. They had another 30 minutes to go, so I’m sure they didn’t mind.

Be safe.

Cats and dogs

Night shift: Nine calls; one treated on scene; two assisted-only; two by car and four by ambulance.

Stats: 1 Palpitations; 1 Lacerated ear; 1 Drug o/d; 1 Head injury; 3 eTOH; 1 Hypoglycaemic; 1 Assault.


I wish the rain would stop for a minute. It's relentless and could fill a fireman’s helmet in seconds (I know L and S will appreciate that one) :-)

The first call was given as ‘chest pain’ but the 59 year-old man in the hostel for whom I’d been called denied this when I arrived. A crew was on scene and one of them knew the man well enough to tell me that he is a regular caller. Tonight he said he had palpitations and that he was diagnosed as having AF. In fact his ECG disputed this and all I could see was an irregular heart beat with deep Q waves, generally where they’d be expected to appear. I’d see this man later on in the shift, at hospital after having been thrown out several times by the staff because he is wasting their time. At the end of my shift I saw him sitting at a bus shelter, in the pouring rain, alone and miles away from the hostel.


The lacerated ear belonged to a 6 year-old boy who was ‘play wrestling’ with an older neighbour (a 12 year old). Things got rough and the little one ended up with a snip removed from the top of his ear, like someone had taken a pair of scissors to it. It would heal and he’d be fine but he needed to go to hospital and get it cleaned and closed. His not-too-impressed dad travelled with him in the car.


A 22 year-old woman who claimed that she had been drugged and robbed wasn’t keen to have anyone of the male gender near her, so I asked a female member of the crew and a WPC to help. Turns out she was drugged but hadn’t been robbed, unless she thought the price she’d paid for her fix was too high.


Another woman who seemed shy of men was the 35 year-old Latvian woman who stumbled in the street and smacked her head. The cut was deep enough to warrant a trip in the car to hospital but it wasn’t, as the doorman who’d picked he up had described when I arrived; a ‘serious head injury’. The lady was adamant that she didn’t want treatment – her English was poor and she spoke only Russian so I used our interpreting service to help me get to the bottom of her problem because I was convinced there was more going on with her than just a fall.

Eventually she opened up a bit and told me that she had problems settling into London life, describing the city as too big and noisy for her and her family. Her child had been having trouble at school too, so her pressures were considerable. A single mum in a foreign land, trying to earn a living to make a decent life for herself and her kids has a mountain to climb in this modern day. Nobody cares enough, so she was struggling. She’d had a drink and got caught out, so I got her to sign the paperwork and let her get the bus home.


Off to Soho next to test the blood glucose of a 30 year-old Glaswegian man who had been out on the tiles with his mates and whose behaviour had caused them concern. He’s a diabetic but his reluctance to have his BM done was nothing to do with him being hypo; he was just annoyed that nobody would leave him alone in his drunken stupor. I tested him on the pavement and declared him fit and drunk, nothing more.


A less than fit drunk lay on the pavement by a bus stop, vomiting pools of rancid red wine around him like he was promoting an art exhibition. He was over 6 feet tall and I called Control several times to get an ambulance crew to take him away but I got nothing; comms were, once again, down and out... like my new friend. So he and I agreed that he could be taken in the car if he behaved. He didn’t behave. He wailed, moaned, flopped around and generally made a nuisance of himself as I sped to hospital. He vomited in the back and it took more than a good scrub to clean the vehicle afterwards – particles were on the inside roof.

In A&E he threw himself from his wheelchair and onto the floor for a dramatic exercise that fooled nobody. He got a bed and zero tolerance. Puddling about in his vomit and being exposed to it so closely in the car was not the time to find out that he was HIV positive.


Far away in the south in a small flat I listened to a young woman tell me about her recent faint and how unconcerned she was about it, as her parents stood by with worried looks on their faces. They’d called an ambulance because she could have fallen down the stairs when she blanked out. Luckily, they had a stair gate at the top. She had a gastric band fitted and her appetite had decreased dramatically. Her BM was low but she wasn’t diabetic and there, I think, was the problem. I advised her to go to hospital and a crew was on scene to take her but, as far as I know, she refused and the crew spent more time with her after I’d gone, trying to convince her.


The rain began to fall with real enthusiasm again and twice I had to run up north for an assault involving a few people. When I got on scene the first time, the police were there and they’d found no-one. The next time, after the 999 call had been made again, I went thinking it was a hoax but two men presented themselves (well I had to find them) and told me they’d been set upon by a gang of other men earlier. They had minor cuts and bruises and I treated what I could on the spot and left them to worry over whether to bother reposting the incident to the police.


At the end of the shift I was sent to an address with no easy access and spent ten minutes trying to get close enough to the location to do any good before an ambulance arrived and we all piled into the street together. An elderly man had got himself drunk and fallen down stairs. I didn’t see him because the crew dealt with it. I went home instead. It was still raining.

Be safe.

Damage control

One lucky driver...

Night shift: Eight calls; one gone before arrival; one assisted-only; one by car and the rest by ambulance.

Stats: 1 RTC with invisible patient; 1 Cut wrist; 1 Faint; 1 ? # ankle; 1 eTOH; 1 DIB; 1 DOAB; 1 RTC.

None of us appreciate being dragged four miles on blue lights to a RTC where the patient has decided he would rather just go home and not bother to inform us of his change of heart. Luckily, I was the only one assigned and I was able to cancel the ambulance (not that one had even been sent yet) and thus avoid even more waste of resources. The driver who’d hit the cyclist told me the 27 year-old man had a head injury and was knocked out for a few seconds after colliding with his car as he cycled the wrong way round a roundabout. The police arrived and I thought it best if the driver continued his story while they were writing it down.

The patient, meanwhile, had left the scene and that meant paperwork for no reason and a long trip back to my own area.

Another call on which nothing but a solo (me) could be tasked because there was nobody else available, took me to a hotel in which a 28 year-old Lithuanian member of staff with perfect English had cut her wrist on a broken wine glass that she’d been stacking in the kitchen. The quick-thinking chef followed her as she made her own way to the back room, where the first aid kit was stored and he put pressure on the wound as soon as he saw it. The incision was very deep and close to her Ulnar artery – she was very lucky not have severed it and the actions of the chef, who had applied the pressure and elevated the arm immediately whilst waiting for the first aider to get to them from the 9th floor, had saved her a lot of blood.

By the time I arrived, the bleeding was almost under control and I was able to fix another dressing and place a sling on her for the trip to A&E, where she’d need stitches. The poor woman was terrified of her own blood and looked away as I examined and then covered the wound. I took her and a colleague in the car because there were no ambulances around and, to be fair, she didn’t need anything more than first aid and definitive care in hospital.

A 71 year-old woman fainted after having a meal at a swanky club in one of the better parts of town. She was on the floor when I arrived and her husband and a few friends were in attendance. She was conscious but still very pale and unwell. She had a history of high blood pressure and was taking Atenalol for that; this drug slows the heart rate down and sometimes the blood pressure falls a little too low and a faint results.

I sat her up to gauge her condition and sure enough she began to feel unwell and faint once more. She vomited a few times on the plush carpet as the diners around her looked on. The staff moved everyone out of the room, leaving a few lovely and delicious looking deserts behind. Tempting as they were, I still managed to look after my patient until the ambulance arrived. The crew were momentarily distracted by the food too though.

An unusual twist to the next call, which is for a 26 year-old female (who happens to be nearer 40) who has fitted. When I arrive, there is a police officer or two around because she has collapsed outside the local cop-shop and her husband, who is also there, is an off-duty policeman. She has recently had a miscarriage and for some reason her husband thinks she may have fitted for a few seconds before falling to the ground but she is only complaining of ankle pain, so I have a look and her leg is swollen at the ankle; it feels like jelly down there too, so I assume she has broken it on the way to the floor as her husband struggled to keep her upright.

She must have fainted – although a fit isn’t out of the question, she has no history of seizures and is more likely to have fallen down in faint if she is still under the strain of her latest miscarriage (she’s had three to date).

I give her entonox and it helps but she’s losing the feeling in her toes and this means her circulation is suffering. The ankle is at a strange angle, so it will have to be straightened out. I wait until the ambulance crew arrives and they can help me support the limb for splinting. This straightens it out and, with a little more pain she can once again feel her toes.

After a useless long run to the City for a drunk person with a bleeding face, for whom another FRU was already on scene and dealing, I returned for my break and found myself at the station for much longer than normal on a Friday night. This pleasant hiatus ended though and I got a call that took me into the West End for what amounts to the most typical call type for the weekend; a drunken, vomiting female.

She was in a doorway with her friends and two PCSO’s were guarding them. The patient was an 18 year-old who was throwing up and flopping like a heavy-headed baby in the stinking, rain-soaked entrance of a commercial building. Three of her mates were there; two of them fairly sober and sensible and the other just as drunk, although able to wail and whine about how bad it all was for her. She’d probably spent £40 tonight just so she could feel hard done by.

Initially the reception I got was frosty and disrespectful but I think I charmed then onto my side when I explained how ridiculous it was for them to be in this condition when they were vulnerable and depriving a really ill person of an ambulance. The two sober girls seemed to get it and, to my surprise, the head of my patient even nodded in silent, shameful agreement.

I asked for the Booze Bus and it arrived very swiftly. One of the PCSO’s had very kindly donated his hi-vis jacket to cover up the vomiting girl’s dignity. He must have been new to the job because you just don’t do things like that with stuff you need to wear. I managed to save his uniform from disgrace when the girl attempted to vomit all over it. She got a blanket instead.

As usual, the Booze Bus crew were magnificent and efficient, sweeping away the human debris from that doorway in quick time. I took the girl’s friends to hospital in the car, so that they could join their mate while she recovered.

On the way back up Charing Cross Road I saw what looked like a small woman being chased by a larger man. In fact, she was a plain clothed police officer and she was running after the man in an attempt to arrest him. The handcuffs she was brandishing helped me to come to that conclusion and as she raced across the road after him I thought she might need a hand, especially when she caught up with him but he overpowered her, throwing her to the pavement. My business or not, I am not the type to sit and watch something like that when the street is full of people who could have given the officer a hand, so I got out of the car, ran after him and grabbed his arm, while the cop held onto the other one and tried to cuff him.

Three or four other men appeared around us and began to have a go at the police woman – telling her that she had no right to arrest him because she was on her own and that it wasn’t legal. I think this is nonsense but maybe one of my police readers can confirm this. As far as I’m concerned, a police officer can arrest someone, whether they are alone or not.

The cop’s very large colleague showed up and took over from me. She had no radio and no chance of getting help if things had turned nasty (my radio, as usual, wasn't working) and, as I said, whether you judge me to have done the right thing or simply interfered, it’s in my nature to help and I’d do it again, despite the obvious risk. That female cop had a lot of guts doing what she did in any case.

Soon after that excitement, a call to a 4 year-old boy with DIB took me into the Oxford Street area in support of a crew that had just arrived as I pulled up. The boy had bronchitis and now an infection was making it worse. His guardians spoke very little English so what information we could glean was very limited but the sound of him coughing was enough and so he went to hospital.

A DOAB next and for once it was a female. The Russian woman was fast asleep, smelled heavily of alcohol and had her bag, phone and long leather boots around her as she slumbered. She’d actually settled in for the night. No wonder she scratched me when I continually harassed her to wake up and get off the bus. It took a few more minutes than usual and I think I was treated to a lot of Russian expletives but eventually, like all the others, she had to comply and get off.
As I prepared to leave the scene, she walked straight back onto the bus and the driver happily drove off with her and a few other passengers. Another complete waste of time and tax.

As I crept towards the light on a promise that I would make it home on time, the heavens opened up and I was sent a job that was almost certainly going to make me late. It was a RTC involving one car that had careered at speed into traffic lights, flattening the post and sending the red, amber and green mounts flying across the road. When I arrived the car was empty but a woman called to me and said that the driver had got out and been taken into a little shop, where he now sat with his head in his hands.

The rain had been persistent all night but now it was torrential; the worst kind of weather to be the only blue light on a crash of this type. Traffic was beginning to build on the road and my car was blocking the scene for safety, so buses and large vehicles were having trouble negotiating around me and it was only going to get worse.

I was soaked through by the time I got the man to my car and sat him inside. He’d already been up and around so he was very lucky to be walking. His windscreen was bulls-eyed twice; once by his head I suspect and again by a smaller thing that had impacted when the car stopped suddenly. This lesser crack was probably caused by his mobile phone, which I found on the floor of the driver’s side. It’s very likely, but not definite, that he was on his phone when he crashed. There seemed to be no other explanation for his abrupt loss of control on what was (at the time of the crash) a quiet stretch of road. He was probably texting.

Within twenty minutes the fire service and police were on scene in some numbers. Exposed electrical cables from the traffic light that had been wiped out and the crushed engine of the car necessitated the LFB’s presence but, typically given the time of the day, there was still no ambulance.

A crew arrived almost half an hour later and the patient, who’d spent the duration drying off in the back of my car, was finally collared and boarded for removal to hospital. It all seems a bit open-stable-door but the same precautions applied, even though his neck was more than likely in good shape, which is more than can be said for his car.

Be safe.