Stop the cavalry

I found this article from 2001 during a bit of research - things haven't changed much.

Night shift: Six calls; one left at home; two by car; one by police van; two by ambulance.

Stats: 1 Dislocated elbow; 1 ? Drug overdose; 1 Chest pain; 2 EP fit; 1 eTOH.

One of the best dislocated elbows I’ve ever seen presented itself on my first call of the night after a 25 year-old Brazilian woman fell down the escalator at a tube station. Her heavy case fell and she tried to stop it but ended up following it down a few steps. Her arm did the job of stopping her vertical journey but it cost her the complete dislocation of her humerus from the radius and ulna so that it stuck out latero-posteriorly and looked like someone had just twisted it in an attempt to remove the lower arm. This type of dislocation is extremely rare.

Amazingly, she didn’t complain at all and told me it was ‘out of place’ when I examined her – yes, it was and the underground staff attending were amazed at the sight when I finally revealed it once layer upon layer of clothing had been carefully removed. She had a good distal pulse and a healthy capillary refill, so she went in the car, with a stable sling in place. Her routine will be x-ray, morphine and manual and probably aggressive reduction of the joint.


Oxford Street next for a 35 year-old female who apparently left a taxi to get money from a cashpoint but found herself without transport when the driver, who obviously got impatient or just didn’t like the look of her, threw her bags out and drove off. So, she collapsed in the street and MOPs gathered around her as she ‘behaved strangely’ - like she was having a fit.

A crew was with me when I arrived and I could see that, although she responded to pain, she was unwilling or unable to stay awake. Her pupils were tiny and her respirations were slow and shallow. On the ambulance she was given 800mcg of Narcan and her sleep continued, except when she had mini-fits of consciousness that made her flail around and lose bowel control.

She went to Resus and complained bitterly about having to take her top off, so she ran around the room making a nuisance of herself. Soon enough, I thought, she’ll fall down and go to sleep again.


At a train station a 49 year-old man had chest pain and a recent cardiac history with angioplasty, so when he told me he had unresolved pain despite GTN and aspirin, he got morphine to help. He threatened to collapse there and then but I think he was more anxious about the possibility of having a heart attack than the actual event taking place – his ECG said no but he went to hospital by ambulance.


After a break and a wasted journey out to a ‘vomiting with closing airway’, I got a call to an epileptic having a seizure. The crew arrived and together we headed up many, many flights of stairs – ignoring the lift for some strange reason - to the top floor, where we wheezed and panted as the 23 year-old woman’s mother explained that her daughter had been fitting irregularly and unpredictably recently and this latest episode worried her.

She was trying to sleep it off in bed when I rudely interrupted her rest and started my obs – she was looking normal except for a fast pulse, which is to be expected and then I handed over and left her to the crew so that a decision could be made about what should be done. She was left at home because I was still outside when the crew appeared patient-less and empty-chaired.


In the wee small hours a man was seen lying on the pavement ‘not moving’ and I went to check it out, asking that no ambulance be sent because the area I was heading to is notorious for this kind of sleeper – drink or drugs... or both. The police were on scene and two officers were helping the young man to his feet. Initially he was sluggish, sleepy and uncommunicative but a few minutes into the routine questioning carried out by the cops he reeled on one of them and was forcibly taken to a wall, pinned against it and handcuffed for his attitude.

I was about to put him into the car when this happened and of course I changed my mind. He would be travelling in a police van to hospital for what may or may not have been a drug-induced problem. On arrival, however, he sparked up and admitted to being a diagnosed depressive and drinker. ‘Why were you lying in the street?’ I asked. ‘That’s what I do’, he said.

He had been shopping and had a little bag containing tobacco, a can of soft drink and a can of dog food – hopefully for a dog and not himself. He was probably a waste of A&E time but it was quiet in the department and he hadn’t given the police an address to take him home to, so there really was no option. In the end I think he lied about his name and was generally cagey about where he lived because he just doesn’t like authority.


There’s nothing like causing a bit of trouble at 5.15 in the morning, so when a call for a ‘fit’ came in and I was sent to Horseguards I discovered that it was a soldier on the morning parade that had collapsed. Unfortunately, soldiers and horses were out in the dark, standing to attention amid the sounds of bugles and police motorcycles were controlling early traffic, including myself until I explained that I had to go in to attend this patient. Then I had to U-turn with an ambulance in tow, in front of the arriving royal car, stopping it in its tracks, to get through the gates and into the courtyard of Horseguards Parade.

We were ordered into a corner so that the royal dignitary could drive through on his way to inspect the soldiers and then a medic explained that he’d taken care of the patient and that it was nothing more than a stomach ache. An officer came over and introduced himself as the regimental doctor, saying much the same thing – the soldier was fine and we weren’t required. I have to say I felt very unwelcome and in the way. They’d already held up the parade because of us arriving, so I sensed they just wanted shot of us.

Once out of the area, I parked up to do the paperwork but another call came in about the soldier. This time I was to go around the back, to the parade ground itself. Police ushered me to a patrol car, inside which was seated a young Guardsman, in full uniform and great coat. He explained that he was epileptic and had fitted during the parade. He also told me that his medication was being ‘weaned’ off him. Now, I can’t understand this because epilepsy is something you can’t be weaned off – it’s not a bad habit. Having his drug cut in half meant he was bound to have a seizure as far as I’m concerned.

What struck me as emotive, however, was the story behind his condition. This tall 28-year-old Sergeant had been on patrol in Iraq when his squad was hit by an RPG, killing two of his comrades instantly, right in front of him. He sustained a head injury and this led to his epilepsy, which had been controlled by Epilim until now.

I found the whole thing worrying but, as an ex-army medic, I understood the politics of army life and sometimes things aren’t cut and dried. Sometimes you risk your life and get kicked in the face when you’ve survived.

He was an amiable man, very polite and determined to get on with his life – he has a plan for his family’s future and that’s something he can concentrate on while he copes with his condition.

Be safe.

Criminal offence

Night shift: Five calls; three declined; two by car. No ambulances tonight.

Stats: 1 Eye injury; 2 eTOH; 1 Head injury; 1 Vomiting.


I was told I looked a bit grey and unwell last night by a colleague. Maybe I’m working too hard.

We were short on ambulances tonight, like last night, so I was Control’s car-bitch and my first patient, who tripped and drunkenly fell onto her face outside a pub needed a short car journey to A&E more than an ambulance and crew anyway.

She had a huge swollen eye but the eyeball itself was in good order, although she couldn’t see from it due to the puffy, closed upper lid. She will be lucky to have escaped a fracture, judging by the severity of it. She was, as you can imagine, quite distressed about her injury and she wasn’t too drunk, so it was more of a lack of judgment that made her fall than an inability to stay upright. I drove her to A&E where friends met her and she chatted to them about her horrible night out.


I spent almost 4 hours of my shift giving a statement to the police as the result of the next call. My CRU colleague requested I convey a drunken 23 year-old man who was with his fiancé and a friend. He’d been celebrating his birthday but the alcohol had brought out the worst in him (or something else had) and he was verbally abusive from the start. Even then, I felt, with his fiancé on board, he could be taken home to sleep it off rather than into a crowded hospital where his language would cause concern. He spat expletives as if they were normal grammatical additions to conversation and I had to warn him many times about his behaviour towards me but he persisted in between strange calms.

At one point the door alarm on the car sounded and I realised that he had opened his door while I was moving. Normally the locks are on but I must have forgotten to engage this one and now he was attempting to get out of the car. I stopped and he stepped into the road, shouting as he did so. His behaviour was manic and bordering on psychotic.

I managed to get him back into the vehicle and continued the journey. I still had a duty of care and his fiancé, who’d been trying to quieten him down, was my concern too. For safety’s sake I requested that police meet us at his home address. Amid continued shouting and verbal abuse, some of which was extremely threatening towards me, he leaned forward and grabbed my shoulder, pulling me back into the seat. I disengaged his grip and warned him that the police had been called. Ironically, a police operation was taking place where I’d stopped and an officer asked if I was okay. I told him what had been going on and the man was promptly arrested.

This incident will no doubt cause the exponents against my role in conveying patients to say ‘we told you so’ but this risk is inherent in all patient transfers, in an ambulance or a car and his behaviour could not be measured accurately until it was too late. He didn’t become physically abusive until later and his language is something we all deal with on a regular basis. I agree that it may not be a risk worth taking and if his fiancé had not been with him I wouldn’t have carried him at all. Lesson learned though - next time, he/she or it will be thrown out of the vehicle.


On returning to my station a large piece of my car fell off and that put a damper on the night for me. Now I had a car off the road and it took me another two hours to get back on and only after ‘borrowing’ a vehicle from another department. Now the rest of my shift would involve ‘clearing up’ calls that were waiting, including a 30 year-old man who’d been assaulted – a girl had cracked a bottle over his head in a pub. He was an amiable young guy and he declined to go to hospital, so I checked him out and decided, as the bump on his head was almost three hours old, he may as well stay where he was.


This was swiftly followed by a call for a 22 year-old female who thought her drink had been spiked. The truth is, she was drunk. Her friends were with her and agreed to take her home to sleep it off after she declined to go to hospital.


Finally, as the rain-soaked battle mud settled in London I was sent to an 18 year-old man who was vomiting for the past 10 hours, apparently. His mother was with him and he did look rather pale but she wanted me to give him something as a quick fix because they were driving back home (a four hour trip) and she didn’t want him heaving up all over the car. Fair enough but at his age there was no quick fix and he was probably suffering a viral infection or had eaten something bad. Either way he was going to go through the vomiting motions until his brain got the message.

They didn’t fancy spending an eternity in A&E so I left them to sort it out with advice to call a GP or go to hospital if it continued.

* The stupid man who went for me in the car was fined and now has a criminal record.

Be safe.

Full moon madness

Night shift: Twelve calls; two declined; one assisted-only; three treated on scene; one by car; five by ambulance.

Stats: 2 Faints; 1 Fall (eTOH); 1 eTOH; 1 Chest pain; 3 Head injuries; 1 Hyperventilation; 1 Glass in foot; 1 Facial injuries (assault); 1 Blocked catheter.


I came in tonight and was told our HQ had been under attack from knife-wielding Gangsta-types who had spilled in through security during a fight which raged in the street. At least our Control colleagues got to see what we have to deal with out here at times.


A 71 year-old man collapsed in a theatre and this is not unusual in London’s old and very hot auditoriums – we get calls like this almost every day. This time, however, I was told he’d fainted twice before and although no cause had been identified after a barrage of medical tests, his pulse was too slow for his age (around 56bpm on average). His ECG and other readings were normal... it was just that slow pulse that bugged me.

I was sent an Urgent Care crew, despite asking them not to send anything yet until I’d checked the man out properly, and I used the opportunity to spend more time checking his vital signs and looking at his pulse rate to see if it would recover. After almost an hour with him, the rate hadn’t really changed much... it was nearer 60 than 50 but it still wasn’t right. He, however said he felt better and didn’t want to go to hospital, so after my usual three attempts, I gave up and he got a full report to take to his doctor on Monday.

I told him I was from Glasgow and he asked me the same standard question that everyone who is not from Glasgow asks... ‘are you Celtic or Rangers?’


Wolfe-Parkinson-White Syndrome can be fatal if not taken seriously, so my next patient, a 28 year-old woman suffering this condition who fainted in a restaurant got more of a priority response from me than she did from the staff who’d called after she fainted, recovered and felt like passing out again. Of course people faint all the time but here was a patient with a reason behind it and the possibility of deterioration or even sudden death, although unlikely.

I spent a while with her and her husband and got to know her history – she’d had two ablation treatments carried out and it’s possible they hadn’t been completely successful. It was equally possible that something else, something entirely benign, had made her faint. I wasn’t prepared to take the risk and I got her to hospital as soon as possible.


A fallen 49 year-old, who’d attracted the help of a few concerned MOPs, including a St. John Ambulance volunteer who just happened to be in the area, was drunk and nothing more. He reeked of booze and stale cigarettes but denied it of course. No wonder he fell on the pavement.

He had no injuries but got a Red response for a ‘head injury’ that didn’t exist. He got an ambulance of course.


Another non-runner who got an ambulance and a Red category was the 20 year-old man who fell asleep on the pavement at a bus stop. His can of Stella, which was rolling around him as he slumbered, was the give-away but it still didn’t stop the decent, honest, hard-working MOPs from dialling 999 and stating that he was ‘passed out’.

When I got there he was sitting up and the two female MOPs who’d called sheepishly informed me that he was 'awake now’. That I could see and further investigation revealed that he was also drunk, on drugs (‘I had a bit of weed’), on the streets and not interested in going to hospital. As interested in fact as the hospital would have been to receive him – they were extremely busy tonight.

So, after checking him out in the ambulance, I bundled him into my car, drove him to a quieter place, gave him a blanket and set him down in a doorway where I knew he wouldn’t be disturbed all night as he slept. He was very grateful.


One swiftly after the other when I am sent up to Charing Cross Road, which is already filling with ambulances and police for other incidents - for a 20 year-old man ‘having a heart attack’. An unlikely call given the nature of tonight’s Reds and this one joined the others as a wasted run. He was lying on the ground, with police officers and his mates around him. He was on anti-depressants and had a history of SVT but his pulse was regular and not at all tachy. He wouldn’t speak to me at first and had been the same with the police – this is not the behaviour of someone who is having a heart attack. He just didn’t want to talk.

The crew arrived as I was finally getting through to him and he told me he had chest pain, so of course that will be taken seriously now but he is known to the crew and they have had this from him before apparently.

Meanwhile, just up the road a man has fallen and now has a head injury and I’m asked on the radio if, when I’m free, I can go and attend to that call. I free myself up as soon as the crew have taken over with my chest pain man and walk up the 30 or so metres to the bar where the man fell. The police come with me because they haven’t received any calls about it and they’re curious. It’s also good protection for me because the crowd is getting ugly.

The man is sitting on a wall outside the bar and the doorman tells me he is okay and wants to go home. He has a minor cut to his forehead and is blind drunk, so no wonder he fell. I ask the man if he wants to go to hospital (guess how many times I ask) but he just wants a cab, so me and the two cops leave him to it.


A call to Leicester Square for a female who was having an asthma attack turned out to be a drunken woman who was hyperventilating and whose friends were frantically searching for a paper bag and had come up with a handful of dodgy newspaper from the pavement as an alternative. This call was routine and nothing at all but an ambulance trundled up and she was taken into the back of it to rest 'til she calmed down. While she did that, I was asked by a police officer to check on a girl at the north end of the square and I made my way up there to find a very, very drunken 19 year-old Bulgarian girl with her friends. She had fallen three times onto her head and now had a nasty swollen lump over her eye. Her mates swore that she didn’t drink but she was drunk on something because her behaviour was outrageous.

Head injuries can produce varying behaviour, including combativeness and I was very concerned that this young woman was in trouble. She certainly wasn’t coming with me in the car and her friends turned out to be a real handful too, as the cops around me struggled to keep them in line.

A fight broke out not far from me and a man turned up with a head injury and a cop in tow. His injuries looked severe enough to merit a trip to hospital and now I had this misbehaving Bulgarian girl and a recently beaten up 18 year-old man to deal with simultaneously. It was a tricky balance and I asked Control to send me two ambulances – an act I felt would have me condemned for the rest of the shift. Still, neither of them could travel with me and they couldn’t go together in the same vehicle.

The Bulgarian kicked off with a female police officer as she sat in my car waiting for the ambulance to arrive and had to be restrained a little, such was the madness of her attitude. Again, I think the head injury had a lot to do with that.

When the ambulances showed up, the head injuries were put in their appropriate place and I checked back on both. Hungarian girl had calmed down and thanked me with a long, tight hug and cheek kisses that were beginning to feel uncomfortable because I couldn’t break her grip (I must be getting old). The assaulted man now had thoracic spinal pain and I found a pattern bruise over the area of his back where he felt discomfort. Someone had put the boot in there (as they had done with his head), so he was collared and boarded. Doing the same with Bulgarian girl would have been impossible, even though she could have done with it as a precaution – she was far too feisty and I now knew that her hug-grip was Olympian, so there’d be no attempt at being silly.


As I cleared the paperwork for those calls, I received another and was on my way to a police station, inside which was a 29 year-old female and her boyfriend, along with two police officers. She’d been running away from someone who was threatening them after a bust-up outside a club and, in order to flee faster and more efficiently, she’d removed her high heeled shoes. This meant she was running barefoot and somehow she managed to run across broken glass in the street. What are the chances, eh?

As she gave her harrowing (ish) account of what had happened to the officer, I examined her foot – I gave it a good wipe down and then saw the problem – she had a sliver of glass embedded in the sole of her foot, right in the middle. I called off the ambulance and removed the offending glass while she winced and talked at the same time; quite a trick.

Now that the glass was out I checked the rest of her foot again and confirmed that all was well. But no, wait a minute, she still had some discomfort. When I pressed on the pad of her sole below the big toe, she said she felt something sharp inside the skin. I looked at it again and broke news to her that would probably embarrass her for a while to come. ‘That’s just a verucca’, I said... medically.


An alleged robbery-assault that resulted in a 29 year-old Irishman being beaten up and left with facial injuries, led me to the drizzly street where police were interviewing him and he was steadfastly refusing medical attention. I managed to befriend him enough to clean his wounds, which were minor to be honest, and he was passive enough, but when the officers asked him about who’d allegedly robbed him again he did something quite comical – he said ‘she took my wallet’. Now he’d been saying that a bunch of blokes had removed his wallet, taken nearly £500 in cash (do people really carry that much around on a night out?) and then thrown his credit card, and the empty wallet, back at him once he’d been soundly beaten.

‘She?’ said the very cynical police office who’d just asked me to travel back to the police station with him and an accompanying officer because they had no vehicles to do it.

‘Yeah, it was girl that robbed me’, he said unconvincingly.

I watched the police officer’s face harden and he turned to me and said, ‘I won’t take up any more of your time, thank you anyway’. That was code for ‘we are going to have another chat with this idiot, so you are free to take another call... something more important perhaps’. Then another fight started down the road and I got in my car and slunk away towards coffee if I could find it.


Later I was asked to ‘sign off’ an Urgent Care crew that was dealing with an 80 year-old man who’d fallen and cried out, causing a neighbour so much concern that she called an ambulance. The man’s daughter arrived and was able to explain that his urinal catheter hadn’t been changed for three months and so that was probably the problem. Sure enough, the old man was complaining of burning pain at the catheter site and a district nurse was called out to deal with it. I signed the PRF off and left them all to it....

...Until I went back to collect the ECG/defib they’d left behind.

Be safe.

Red, red whine

Day shift: Seven calls; two assisted-only; three by car; two by ambulance.

Stats: 1 Back pain; 1 Palpitations; 1 Unwell alcoholic; 1 Lacerated hand; 1 Near faint and panic attack; 1 Faint; 1 Cut above eye.



The first call was a Red simply because the caller told us the patient was ‘not alert’. This is one of the vaguest and most confusing things to ask a MOP – ‘Is the patient alert?’ What kind of response do you really expect from most of the population, especially if they are not English-speaking? The 33 year-old man had slipped on a newly washed floor (the wet floor signs were up) and fallen onto his back, like that clumsy and obviously very blind woman on the TV claim-for-blame shark ad. He now had a tender coccyx (as you would) and the pain was radiating to his pelvis and upper leg. This is what happens when you land on it hard – it gets bruised.

The man was fit and well and there was no reason to believe he had anything more than a minor injury – yet it was given a Red2 on the basis of his ‘not alert’ status. And yes, I know, you can fracture your coccyx and it’s painful but it’s not life threatening. This category is reserved for immediately life-threatening or at least potentially-so calls. Even if ‘not alert’ in the absence of a head injury, would this be such a call? Does smashing you tail bones on a hard floor from standing constitute a near-death experience? Is the brain somehow directly connected to the tail?

This call became a resource-drain simply because the guy on the floor said things like ‘I can’t move my leg’ and ‘it’s really painful’. But he scored his pain at less than 5/10 and he stood and walked, with support. In fact, after a breakfast of Entonox, he declined his trip to hospital and hobbled right back into work. I’m just glad he’s tax payer.


Next, a 23 year-old described as having ‘chest pain’ was actually experiencing palpitations. She had a one-year history of Lupus (SLE), so any organ can be affected if she has a ‘flare’ and in this case, her heart seems to be involved. The disease is degenerative and if her heart is being affected adversely this is not a good thing for her future health.

She was stable enough when I arrived; no chest pain, just that fluttery feeling when your heart is racing. The crew arrived a few minutes after me and we took her out of the crowded and very noisy hotel reception (it’s a large tourist hotel...mainly for young people) and into the quiet ambulance for further tests and a trip to hospital.


As I ran to yet another Red call, this time for a 41 year-old Polish alcoholic resident at a hostel who was having ‘breathing problems’ that didn’t exist, I heard a call come in for a cardiac arrest. An 18-month-old child and another child had been involved in a road traffic incident. This is why we have the colour red in our system.

The man sat in his grotty, litter-decorated room, panting and puffing as if he’d just run a Marathon. He complained bitterly about not feeling well and being sick after telling me he hadn’t eaten for two days and had just been drinking cider and cheap white lightning. ‘Well, no wonder’, I said, suggesting the obvious but, as usual, there was no acceptance of a pre-written fate – no acknowledgement of something brought upon himself. It’s a disease they say. It’s a state of mind eventually, I say. Smoking can be beaten with determination and will-power and so can an addiction to alcohol – it’s all about what it’s worth to an individual to stop.

I took him to hospital myself and once in the back of the car his theatrical breathing stopped (not his breathing per se of course) and his ‘vomiting’, in which he’d been up-chucking gobs of plaster-looking phlegm into a small bucket (and sometimes out of his third floor window when the mood took him), ceased instantly, even though I had provided him with a perfectly good yellow clinical waste bag for his pretender-to-the-throne vomitus.

He was actually relaxed by the time we got to hospital and I’d like to think that my calming manner had influenced his mood but no, like almost all of these individuals, their purpose for going to hospital is to get into an environment where they can be ‘cured’ of any immediate problem that interferes with their drinking routine. On the way out of his room, he tried to light a cigarette – so his ‘breathing problem’ was of no significance to him as long as I was there because his attitude was pretty much that I would clean up any consequence for him.


On a building site, three storeys up where a hard hat is required if you want to keep your skull intact, a 55 year-old man was handling a hoisted RSJ when it got caught and then slid into his hand when it was freed. This heavy piece of steel sliced into the joint of his hand, at the point where the metacarpals meet the fingers, ripping it open and probably breaking the bone there. A cycle colleague was on scene and had already dressed the wound, which had stopped bleeding. I was asked to take him to hospital in the car, rather than an ambulance, which is fair enough.

He was a good-humoured man and the three of us managed to have a smile and a joke or two before I took him to A&E. The pain in his hand was bearable, he told me and he didn’t want analgesia for it – but then he didn’t know he would be waiting for two hours in hospital before being seen – poor bloke.


A Red call for a ? Stroke at a museum turned out to be a near-faint that converted into a panic attack with hyperventilation and clawed fingers (this occasionally happens). The whole ‘can’t feel my fingers’ triggered an emergency call for a suspected CVA but the lady was embarrassed by the fuss that had been caused and sat munching on a bread roll as I completed all the obs I needed to confirm that she didn’t need to go to hospital if she really didn’t want to. She got the usual three offer deal but, sensibly, declined.


Another patient who declined was the 85 year-old female who fainted for ‘ten minutes’ according to her friend. That to me is a wee bit more than a faint, which is generally defined as being less than a minute and I advised her to consider going to hospital. She was very strong-willed about seeing he GP rather than going into A&E and so I did all I could on scene as she recovered fully from her dark spell. Her ECG looked a little long and slow in the P-R interval department and her pulse stepped up in pace from slow to normal. Her BP remained lowish for her age (115 systolic) but she insisted this was normal for her and that she regularly played tennis to keep it that way (pulse and blood pressure of an ageing athlete then).

Before going to see this lady and her friends at a well-known restaurant, I had travelled to a train station for a man claiming back pain after admitting to having cirrhosis of the liver through drinking. He was already being attended to by a crew so I was redeployed for this patient. The call went from Red to Green in a short few seconds. When it’s red for an 85 year-old ‘collapsed’ that’s a genuine worry; when it goes green again, all things have to be considered.

So, she got to sign my PRF and she was given three opportunities to go to hospital. She seemed fine but I made her promise me she’d see her GP immediately. She told me she would but after her next scheduled tennis game.


My peddling friend (cycle paramedic) was given a call in Oxford Street and I sensed a perfect job for getting home on time. Sorry but sometimes it’s about finishing on time, unless someone’s life is at risk of course. In this case, a 50 year-old woman had walked into a glass door in a department store, cutting her eye and landing on her backside when she fell. She had a small laceration above her eye and hadn’t been knocked out... in fact, she had no other injury at all, so I drove up there, collected her and got her to A&E, with her husband, who had shown up in support, giving me ten minutes of paperwork and ‘filing’ to do before finishing my tour of earlies.
Next up... the dreaded weekend nights.


Be safe.

Assembly line medicine

Probably the last thing you want to see after a hard-drinking
night out.

Day shift: Six calls; five by car; one by ambulance.

Stats: 1 Chest pain; 2 Faints; 1 Back pain; 1 Numbness; 1 head injury.

A grey, rainy day today and the first call was for a chest pain in poshville, W1. The 77 year-old man woke up with tightness in his chest and his wife called an ambulance. The apartment was one of the nicest I’ve seen – very light and open with the usual private lift and concierge deal chucked in for a measly five million, or whatever these places cost nowadays. That place would be my post lottery-win London pad, that’s for sure.

Anyway, the crew was just ahead of me and I wasn’t required because the man was stable and there were enough hands to deal with him.


On the subject of Lottery wins – imagine winning fifty-odd million quid on Euromillions and earning £200,000 a month in interest. Imagine going to your bank manager (the new one of course ‘cos you’re not sticking with HSBC or Lloyds, are you?) and saying ‘right, I’ll leave my fifty-odd million in your bank but I need a ten million pound loan over ten years at a fair interest rate for you and I’ll use the interest I’m earning to pay off the loan in that time’.

Now, I’m no financier but I figured out that, after paying the interest every month, you’d still be looking at around £80,000 a month in earnings plus the benefit of buying all you needed with your ten million PLUS not laying a finger on your original winnings. Obviously, I hadn’t figured in the taxman... still nice fantasy. And of course someone is gonna come along and burst this bubble for me, right?


The day seemed to roll out fainters in excess because, as well as hearing my colleagues running to them I was sent to two in a row. The first was a 23 year-old female bank worker who collapsed on the floor of her open-plan office and began a charade that she had apparently gone through the previous year – same M.O. but no problem ever discovered for her behaviour. She vomited by means of forced retching until phlegm and mucus was deposited into a little plastic food container that someone had obviously contributed (after removing their sandwiches) and rolled around on the floor, giving periodical shaking displays as though fitting, when she clearly wasn’t. When I tried to sit her up, she threw herself back on the floor and when I tried to get her into a chair with wheels so that I could roll her, with the help of one of her male colleagues, out to the car, she deliberately slid off that too.

I asked for an ambulance because I’d had enough of struggling to make her behave but there were none to send and I spent a further fifteen minutes trying to convince her to help me out. All of her work colleagues could see what was happening and it doesn’t make good publicity for a reputation in such a closed environment.

After a long and unnecessary delay, during which she simultaneously went through her ‘seizure’ act and answered her colleague’s questions, I eventually got her to sit on that chair and we wheeled her out of the office, down in the lift and across the lobby floor to the exit, where she finally found the strength to stand up and walk to the car.

During the trip to hospital, she retched close to my ear whilst helping me to fill in the PRF details I needed. Strange but true.


Even stranger was the next fainter – a 50 year-old tourist woman from Italy. She was in a shoe shop when she collapsed and became unconscious for a short time, according to the staff. Obviously, whether she was unconscious or not is debatable and I asked her all the pertinent questions that might shed light on her sudden condition. She was very wide-eyed and confused and I have to say, a bit crazy looking – on drugs crazy... that type of look.

She initially declined my invitation to take her to hospital but changed her mind after I’d asked her for the third time (I always ask at least three times to be sure). She took my hand without it being offered and I walked her to the car. I would have had an ambulance take her to hospital, considering how confused she seemed to be but there was something naggingly familiar about her behaviour and I thought it would probably be best if I took her myself as it would only cost me 5 minutes.

All the way there I watched her in the rear view mirror and turned my head frequently to make sure I knew where she was. She sat behind the passenger seat – I never allow anyone to sit directly behind me when I am working alone. Usually if I have someone like Lottie out on Obs and she can keep an eye out for me I am much more able to relax but I had to keep tabs on her because I didn’t fancy having an ice-pick stuck into my neck. Okay, my imagination’s gone a little OTT.


After a break I was sent on a mission to recover a person who had fallen from a chair and now ‘could not move’. This sort of call deserves a quick investigation before sounding the bells because history has proven that they were notoriously stupid in nature and didn’t require an emergency ambulance in the first place – but what do you do when you have someone on the floor of your office and you have no first aider on duty, as stipulated by law? Tut, tut.

The 35 year-old Asian lady was like a jelly when I tried to examine her back – she did that pull away and wobble thing that you do when you anticipate pain but don’t actually experience it. She’d either fallen or launched herself off the chair (my money’s on launch) during a visit to a place that helps you find work in the UK if you are not from the UK; it’s a Government financed private business and you will have to forgive my sarcasm but it seems that we are paying taxes to fill the job market that is being created by redundancies and reluctance within the actual UK populace.

I got her to stand up and walk to the car, gave her a bit of entonox which helped and trundled her to hospital in the car. The ‘gas and air’ worked and she complained no more. Inside the A&E department it was chaotic – very busy indeed and a nurse had to announce that the waiting time had grown from two and half to three and a half hours. People were getting off buses in rows to go into the department. What was going on today? Outside in the ambulance parking area, there was an assembly-line of patients coming in, most of whom were in no way emergency cases


For example – a 21 year-old Romanian man who walked into a large department store with his suitcases (he’d just arrived in the UK) and told the staff he had numbness down one side. A Cycle responder was on scene after 999 was called. There was nothing wrong with him except for an emotional crisis at home but I was asked to taxi him to the nearest A&E dept, where he would cause a longer queue.


Then to finish the shift, one of my cycle colleagues gave me a last-minute job – a 4 year-old boy who’d tripped over and smacked his head in the street. He had a swollen eye and a little cut but was otherwise okay. We don’t like quiet children post-injury and he was a little too quiet after a head injury, so I put the lights and sirens on for a while and he sparked up and became a normal just-minor-injured little boy again. See? A little distraction works wonders in diffusing the worrying aspects of children’s illnesses and injuries. Try it before rushing to the phone to dial 999. Please.

Be safe.

Balancing act

Day shift: Five calls; one refused; four by car.
Stats: 1 EP fit; 1 ? TIA; 1 ? fractured wrist; 1 eTOH; 1 Fractured foot.

During half-term holidays it takes about three hours for London to wake up and start calling ambulances in earnest, so it’s almost always slow for me first thing in the morning. This gives me the chance to wash the car, clean and replenish kit and generally catch up with stuff. At around 9am I can forget about these pauses.


A 20 year-old epileptic had a seizure at a train station and a passing doctor stopped to help. The doc was still with the patient when I arrived and I was given a handover that included a little bit of the history behind the fit. The young lady was very thin and very weak looking – vulnerable and fragile in appearance. She was emotional too and gripped my hand as I took a drop of blood for the BM test. I wondered if there was more to her condition than epilepsy.

When the crew arrived and the doctor left, she changed her mind about medical help and refused to go to hospital. So, she was allowed to get out of the ambulance and carry on with her journey – her health, her choice.


Another choice that had to be made was for the 38 year-old woman who was reportedly having a stroke at work. Her best friend and colleague had noticed slurred speech when she telephoned her after she failed to text in as normal before leaving for work, then when she arrived she seemed to have a facial droop accompanying her speech problem, so the friend dialled 999 and got me out to check.

With no medical history of any significance and a slightly high BP and recent stress in the background, I tried to persuade her to go to hospital by ambulance but she didn’t want to. Her facial droop was resolving and her FAST test arm weakness improved too but I was still convinced that she’d had a TIA and because it had probably happened within the past 6 hours, I wanted her to go directly to the appropriate unit for treatment, so I got her to agree to come with me (and her friend as company) in the car. She agreed to do that and was relaxed and happier for it I think. The journey took 5 minutes and she was seen by a doctor within one minute of arrival. In my book, that was a clinical decision that I had to take otherwise the choice was to drag her to an ambulance, causing further stress and upset... or leave her to make up her own mind with the possibility of another acute TIA or even a full blown stroke later on. These are not good options and so she went with me.


Barclays bank must be erring on the side of caution when it comes to promotion these days. Instead of TV advertising, they sent out four (soon to be out of work again) actors/singers/dancers, dressed in corporate blue costumes (a la marching band) around Soho to sing and dance while showing the bank’s logo prominently on a briefcase they each held. I know this because they stopped at my car as I waited on Frith Street, sipping a Latte, turned in unison, waved, gave me the thumbs up, mimed at me to smile (like banking with them is fun), made a ‘wind down your window’ gesture and then proceeded to sing and dance at me for 30 seconds before shutting down like robots, turning again as if on a parade ground and then stomping off in step (sort of) to unleash the same embarrassing ditty on someone else. Up and down the street they went. I thought I’d driven to Disneyworld by accident. Except in Disneyworld, apart from the prices, they don’t charge you interest and fees for showing up.


Fractures don’t figure highly on our list of priorities – not the common upper limb fractures anyway and so you can expect a Green-type response (in other words, we’ll get there when we can) while, quite possibly, some over-acting person lays on the floor rolling around reporting themselves to be ‘feeling faint’ and the ambulance is sent to him/her/it instead. You can sit on your own with a broken wrist, in quite some pain, while we run around after phantom emergencies. It’s a damned shame that we are driven to this on the basis of fear of getting it wrong and the blasé attitude of a computer coding system. A shame, therefore, that a perfectly lovely 75 year-old lady sat in a train station waiting to be taken to hospital for her (most likely) fractured wrist after she’d taken a tumble on the quite frankly ludicrous sloping surface of the walkway leading to the platform.

She was with her son and I got there a mere 9 minutes after the call was made and in this case all was well because I got her to X-Ray within 39 minutes of her fall, which isn’t bad considering what I have just said about the call category. This was entirely due to a human being looking at the call and deciding that, instead of sitting around on standby doing nothing, I could pop up the road and collect this lady for her inevitable trip to A&E. Otherwise, with our system and the demanding whim of some Londoners, she may well have sat there in the cold, not more than 300 meters from the hospital, for hours before being seen.

Yes, she could have walked or taken a taxi and I always bang on about this too but at that age, unsteady on her feet with pain and a history of high blood pressure, it’s reasonable to send someone like me trundling up to carry out the important clinical checks before things are made worse by moving her inappropriately and I always emphasize when teaching about fractures, the crucial element of pain and complications when deciding to go 999 on a relatively minor broken bone.

Her capillary refill was poor, indicating the fracture may be interfering with her radial circulation, so I made a slight adjustment to the angle of the wrist and placed it in a sling to keep it straight. This worked perfectly and I felt warm and fuzzy about having resolved that more significant issue. With blood now flowing properly to her hand (her thumb mainly), the bone could get on with being repaired by the experts... and her own body.


The police called to ask for assistance with a man who was ‘very drunk’ outside the Ritz (at least he had class). He’d been bothering people as they passed by and now he was just incapable of standing safely, so the officers wanted me to take him to hospital if possible. Now, this is a little tricky because he hadn’t been arrested and hadn’t been sectioned but he was drunk in a public place and a danger to himself if he fell down or walked into the busy road, so I agreed to take him to hospital (a place of safety) and, given that I was told he had a violent history, I asked for an officer to accompany him in the back. No ambulance was required and he was as gentle as a lamb, so no problem.

The female officer accompanied him in the car and her colleague drove behind us in the police vehicle. He had already given up a small bottle of amyl nitrate and confessed to being schizophrenic but whether he was telling the truth about his mental health or not was questionable. Nevertheless, he was going to hospital for assessment in case he’d taken in more than alcohol.

On the way there I was asked if I could take the police officers urgently to help a crew who were trying to deal with an aggressive patient. Other colleagues had gone in support of the ambulance crew at the scene but I had two cops with me and they would be needed, so I diverted and got there in less than 2 minutes. The patient was on a trolley bed, thrashing around and causing real problems for the crew. A few more pairs of hands helped out as motorcycle responders arrived and the two officers with me got into it.

Meanwhile my patient sat quietly in the back seat and I kept an eye on him. I wandered off for a few seconds and returned with the female police officer so that we could continue our original journey and when she got in the back, the patient was wearing her police hat. He’d been very amorous toward her in the car on the way in and had tried to hold her hand a few times, so I think he was getting serious about her with the whole hat thing going on.

After a short journey and an unnecessary dispute about whether he was in a place of safety, according to the law or not, I left to continue my shift. We’d been tied up on this single call for nearly two hours.


Then I had to make another rapid decision and risk egg on my face when I was tasked to deal with a 37 year-old man caught shoplifting who had injured his leg. It was out of my usual area but I wanted to help with this because there were no ambulances available.

When I arrived the police were on scene (and shop security staff) with a very irate man with a hugely swollen foot. I was shown a 20 foot wall and told he’d dropped from it onto the pavement below in a bid to escape. A quick calculation of mechanisms said he needed an ambulance but he had no other injury – no pain other than in his foot and he shouted repeatedly to be taken in the car to hospital because the pain was unbearable for him. With no ambulance available and my colleagues busy on other calls, I decided to take him, as he wished, in the car with, yet again, a police officer to accompany him. I got him in quickly and asked for the hospital to be alerted in case he needed to be seen by a specialist or in Resus but when I got to hospital they had taken it as a ‘blue call’.

His injury was isolated and non-life-threatening but the medics insisted they check him over just in case and I got no real problem from them about the decision to advise them of his arrival but it caused more of a fuss than it should have done and it left me feeling a little like my day was punching me in the face. So, I am thinking harder about my convey decisions. I still want to be able to function and save ambulances wherever possible but after today, it might be easier to pass the buck.


Be safe.

Drunk and loaded

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

Stats: 1 Lacerated lip; 1 Asthma; 1 eTOH and vomiting; 1 eTOH and falling down.


I had the pleasure of hosting, on behalf of the Service, a paramedic from Yorkshire and so the first part of my shift was about tours and history and the usual rubbish I can ply people with when they are caught unawares. He was a thoroughly good chap and I enjoyed our chats, which mainly focussed on the differences between London’s ambulance service and his. He seemed suitably impressed with the way things are done down here, so I am hoping his report back home will be favourable. I'm also wondering what it is we are doing right.


So, first off – a 3 year-old boy, reported as being variably 8 years-old and 5 years-old, depending on who you spoke to, fell onto the back of his little sister’s buggy, splitting his lip open and puncturing a decent hole through it at the same time. The bleeding had stopped and his mum was quite happy to travel to hospital in the car (it was a three minute trip) rather than expose him to the further stress of an ambulance. He was bawling his eyes out and took some time to settle down but once in hospital, he seemed to calm.


A wasted trip later on for an unknown person who dialled 999 and proceeded to press the buttons on his phone rather than respond to the call-taker. It was either a hoax or an accidental call but either way, we had to check it out and an area search, that including the public toilets in Leicester Square, led to nothing.


A 23 year-old girl with asthma had an attack at work and one of my motorcycle colleagues was on scene dealing. He suggested that a trip to hospital in the car may be useful but when we got there, she’d pretty much fully recovered and was chatting away cheerily with him after agreeing to go and see her GP about it instead. I wasn’t needed but I spent the next 20 minutes or so chatting to her, her mum and her cheeky cousin, who worked in the same place. While my colleague continued his paperwork and my observer got cornered in conversation, I was privy to discussions about boyfriends who had no sense of direction when it came to faces and other amusing side-subjects. Sometimes the people I meet and interact with make this job a lot more fun - these three ladies did just that.

I left them to it after being offered cups of coffee and a job with a possible one million quid bonus.


Drunken street people shouldn’t carry large amounts of cash on them – for their own good. It was a mystery for me and the police officer who called us, to find a very inebriated, constantly vomiting 34 year-old alcoholic with a plaster cast on one leg, one shoe on and over a thousand pounds cash in his pocket. He wanted to go to hospital and said he had pancreatitis but he wasn’t complaining of abdominal pain – his vomit smelled of alcohol, so all he wanted was a bed, although he could easily afford to check in to any good hotel in London, he chose the 4-star L’hotel d’NHS instead. Rooms are free for a limited time (see the nurse for details).


Drunk number two fell onto the escalators at an underground station and cut his face. He probably broke his nose too; there was evidence of damage to it along the bridge. He’d been rescued by the staff after attempting to continue his travels by tube with a messy, bloody face and a drunken stagger. They caught up with him at a station near me and I was asked to look at him and decide whether or not he should travel. Obviously, he couldn’t and an ambulance arrived to take him away for his own safety.

He was a pleasant Spanish man who apologised every ten seconds for the trouble he was causing and in my book the very recognition of that fact makes it okay with me. So he got smiley Stu and a hand up the steps into the ambulance. Then he went and spoiled the moment by tripping up and once again falling onto his face in the ambulance as he took the last step inside – silly sausage (as they say in the old country... wherever sausages are famous... Germany probably).

Be safe.