All fall down

Day shift: Nine calls; all by ambulance.

Stats: 6 Falls with head injuries (1 with broken nose); 1 Knee injury; 1 Hyperventilation.

This ambulance shift is with Emma and she is a good friend of mine from a few years back. Our first call is to a 45 year-old male who’s lying in the street with an ‘upset stomach’ – this was designated a Red3 and that was the description given. I get upset stomachs but I don’t believe it’s an emergency. When I arrive I realise why it’s been categorised that way; the call has come from the police.

I also know the man on the ground – he is a gel-drinking alcoholic and he can be very aggressive – not violent, just angry. He also smells very, very bad and often defecates into his trousers, leaving the mess there for days at a time. This was not the best breakfast start to the day for us.

Predictably he bemoaned his life and predictably he began to raise his voice as he became more and more frustrated with my crew mate’s questions. Emma has the patience of a saint; I don’t – so he was told to calm down and stop raising his voice.

‘I want to die’, he kept repeating, ever louder. I feel the same - the smell is overpowering at times.

When we get to hospital (police officer on board just in case) he is put into a secure room but he’s not happy at all. The last time I see him before I leave is on the CCTV monitor – he’s curled up on the sofa with a blanket around him - complaining about everything and everyone.


Our next call, soon after, is for another gel-drinker and the evidence is still on the ground next to him. A small bottle of orange, mixed with alcohol-gel is testament to his current condition. The 70 year-old man was seen to collapse and land on his head, opening it up at the back. Two helpful ladies from a nearby coffee shop tended to him until we arrived. He smelled the same as our previous patient. Perhaps the gel-alcohol gets into the urine and gives it that ‘special’ aroma. He hadn’t been incontinent, however, so it was a less stressful dilemma for the olfactory nerves.

He was semi-conscious and hypothermic (32c), so a couple of blankets, some warmed IV fluids (we don’t have a fluid warming system, so I use the ambulance heater) and a blue call to hospital were in order. By the time he reached Resus, he was a little more alert.


Then we went south to the aid of a 46 year-old man who fell in the street as a result of a ‘dodgy knee’ he’d twisted a few days before but ignored. One look at it confirmed that it was sprained at best – fractured or dislocated at worst. His leg was rotated at the knee so that it deviated from its natural line – it was obvious when he lay on the trolley bed. No wonder he’d been unable to walk on it.

We splinted it and gave him pain relief – entonox does the trick for this sort of thing. This time he would have to go and get it sorted.


We were sent on Active Area Cover (AAC)…or stand-by as we used to call it and, as if to prove a point, the next call came from just down the road. A 64 year-old female had fallen on a bus and had a head injury. AAC is fairly new and the idea, combined with call-connect, in which an ambulance (or solo) is despatched as soon as the address of the call is confirmed, is to speed up our response times to your emergency, perhaps saving one or two minutes. That’s all very nice and I appreciate that we need to be with you as soon as possible but a system based on prediction and human folly is bound to fail sooner or later. For the time being it seems to be doing its job. Either that or we are being sent to a specific location and calls are being setup for us. That’s too far-fetched and very cynical of me, I know.

Anyway, despite this wondrous technological advance, they still managed to get the wrong location and wrong bus number, so we wasted a minute trying to locate our patient in the heavy rush-hour traffic of Oxford Street. See? You just can’t knock human intervention.

The woman was fine; she’d fallen onto the back of her head when the bus braked hard to avoid hitting two kids as they darted across its path. Fair enough, the driver had to avoid the collision and maybe she should have been seated, as per the instructions for every passenger BUT I really wish he hadn’t said that he ‘broke’ hard to avoid hitting them. There was worse news for my ears, however, when the police officer attending the scene said exactly the same thing. It irritated me as much as seeing an apostrophe hanging over an S in a plural. Scottish and fussy about my English, that’s me.


We went back to Oxford Street later on to tend to an 84 year-old woman who’d tripped on a defective paving slab and fallen onto her nose. She had two hands full of shopping (and they say there’s a recession), so she was unable to stop herself landing full-force on that facial organ. ‘I heard it crack’ she said with a soft, smiley Irish tone.

The poor woman’s septum was deviated so far to the right that she looked like a prize fighter with a story to tell.


The strangest call of the day next and a FRU was on scene with an 81 year-old lady who woke up in the morning, had a bath, brushed her hair and felt something wet on her hands. She looked down and realised she was bleeding. The FRU pilot examined her and found a huge open bump at the back of her head. It looked like she’d been mugged with a cricket bat, yet she had no pain and no idea how this had occurred.

She had a GCS of 15 and all her obs, apart from her blood sugar, which was high, were normal. She wasn’t diabetic, so her BM was a little suspicious and we searched our minds for a connection. She hadn’t fallen, hadn’t been hit BUT she was taking Warfarin and that seemed to lead me to a reasonable possibility, although I needed a mechanism, like a fall or knock to the head to support it.

Obviously she was bleeding heavily from the wound and so it was dressed tightly and she was taken to hospital where no doubt higher paid people with more time on their hands would work it all out.


If you see an ambulance parked up with blue lights flashing and you are a multi-drop driver, keen to make that urgent delivery, please don’t park so close to the back of the ambulance that the crew can’t lower the ramp to take a non-walking patient on board. If the lights are flashing we are definitely working – not queuing for a coffee and cake at the local café.

A florist decided he’d unload what must have been dreadfully important plants directly behind our vehicle. He was so close that our ramp would have settled on his bonnet, had I been annoyed enough to go ahead and lower it anyway. Our patient, a lovely 85 year-old lady who’d fallen on the escalator at a John Lewis store, was being wheeled out with a head injury. To save us lifting her up the steps of the ambulance, my plan was to put the chair on the lift and gently (safely) raise her into the vehicle that way. She was unsteady on her feet, so it was the kindest thing to do. Mr Florist had other ideas and not even the sight of her having to be walked on wobbly legs made him feel guilty enough. Thank goodness we weren’t resuscitating someone.


We took the lady to hospital and she was directed to the waiting room because there were no beds. We wheeled her next to our last head injury patient, the Irish lady and they both got chatting. I suggested a game of cards.


A quick and easy hyperventilation next. A 65 year-old was having a panic attack at an art gallery and we spent no more than a few minutes calming her down after the MRU bod had started the ball rolling.


The last job came from just around the corner as we waited at hospital. A 12 year-old boy had fallen on his head. He was described as ‘dizzy’. That was under-selling it; he’d been aloft on his friends shoulders next to a busy road – they were larking about and he took a tumble onto the pavement. His tooth pierced his bottom lip, leaving a ragged tear and hole in it as he met the concrete with his face. He hadn’t been knocked out and his mates (there were a lot of them) could have walked him to the hospital but these days, everything is an emergency, right?

Be safe.

Stone cold

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

Stats: 1 Hypothermia; 1 Faint, 1 Hypoglycaemia.

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

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

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

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


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


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


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

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

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


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


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


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

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

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

Be safe.

Random

Night shift: Nine calls; all taken by ambulance.

Stats: 3 Head injuries; 1 time waster; 2 drug overdoses; 1 DIB; 1 stabbing; 2 ETOH.


The first drunken patient I was called to had walked into a moving car as he crossed the road. As he fell, he grabbed the open window of the vehicle (which was still moving) and clung on as he hit the ground, cracking his head open on the road. The driver got a bit of a fright and braked in time to stop his wheels from rolling over the inebriated 25 year-old.

Thankfully, his injury was fairly minor but he still needed to go to hospital because his wound would have to be checked and closed. His friends became obstructive at times and had to be told to quieten down. She was taking the ‘you are a public servant and will therefore answer my inane questions, even if it is interfering with patient care’ approach and I can’t stand people who do that. It ranks up there alongside ‘I pay my taxes and you will obey me’.


The Lithuanian alcohol-gel thief was back in action tonight and I only had to look at the call description to know it was him: ‘30 year-old male fitting, second fit worse than before’. It’s all getting so tiring now. I arrived with the crew and as soon as I recognised him and he recognised me (that strange exchange takes place where I acknowledge he’s wasting our time and he doesn’t give a damn) the game was up. The crew didn’t know him, so he continued to play on it for a while longer…at least until he was in the back of the ambulance.


A strange skinny man was seen ‘shaking’ and behaving oddly in some bushes outside a block of flats, so the neighbours called the police. The cops dragged him out of the hedges with his trousers around his ankles and he promptly collapsed. A crack pipe was found nearby but they weren’t sure if it was his or not. They called us out and I arrived to find him lying on the ground with handcuffs on. He was either truly unconscious or faking it really well.

I asked for the cuffs to be removed and carried out my obs, finding nothing untoward and deciding not to give him Narcan because he wasn’t at risk and I didn’t want him awake and aggressive. I waited for the crew and they arrived ten minutes later. He was hoisted onto the trolley bed and woke up immediately.

His recovery continued in the ambulance as the crew and police interviewed him. He wouldn’t tell them what he was doing in the bushes but I’ve seen this behaviour before (the man with the porn magazine underneath him who’d been found unconscious and half-naked in a doorway). It’s possible that after taking drugs, they become aroused and don’t care where they are when they act on that impulse.


A 70 year-old lady with DIB and sats in the high 70’s said ‘I’m not coming home, am I?’ as she was wheeled from her home by the crew. I couldn’t answer her because I didn’t want to lie. She wasn’t well and her breathing had deteriorated suddenly overnight. I had nebulised her but it had barely had an effect.


Stabbings are becoming common in London and my next call was to a random knifing on a 25 year-old tourist who just happened to be in the wrong place at the wrong time (if that’s even fair to say). He was walking down a street in the West End when a passing stranger allegedly lunged at him, stabbing him once in the back. That was it, no other exchange took place. The assailant walked off and he was left collapsing on the pavement. It’s frighteningly possible that it could have been anyone…you or me, your brother or sister.

Luckily for him, the wound wasn’t deep enough or near enough any vital organs to cause a life-threatening injury but that was just luck. He could just as easily be dying for nothing.


Drunken people’s drunken friends can be very annoying and very entertaining. Another young woman with no tolerance for alcohol – a 23 year-old, slumped in a doorway after being hauled out of a club had vomited a pool of yellow liquid then lay on the ground waiting for the world to go away. Her friends drifted in and out of the scene to make comments as I tried to get her to talk to me.

‘Oh my God, is she going to be alright? What’s wrong with her?’ a random friend asked in a shrill, high pitched and panicky voice (these are the people who won’t survive the next crisis in their lives).

‘Yep…she’s drunk’, I answered. I hope to inspire confidence but I really want to say ‘serves you right’.

This young woman had downed a bottle of Malibu on her own and now her friends were actually surprised to see her puking it all back up as the alcohol kept her in a semi-conscious state.

‘Yeah, I get like that sometimes. You know how you get so drunk that you can’t feel your own legs?’ the shrieker asked me.

‘No, not really’, I answered, wondering if she was decribing this or a stroke..

A cat fight broke out yards from us and this made the loud friends go away but it also made the area that little bit less friendly for me and the crew when they arrived. At least three women were scratching it out for who knows what reason and the men were, predictably, doing nothing to stop it. They were happy to form a circle around the battling females and grin en masse (this, I believe, is the same as chanting but in a more subtle, socially-acceptable way).


I got another mouthy friend later on when I went to deal with a drunken 20 year-old woman who fell on her head when she tripped over herself. She lay on the road with a bleeding scalp and her mate, who was probably twice as drunk as the patient, attempted to stand her up, pushing me out of the way to get to her. She had to be warned again and again to step back and let me get on with it but she wasn’t having any of it. ‘She’s my best friend’, she told me, as if that gave her a licence to make her condition worse. Eventually, one of the club doormen took her aside for a chat.

When she was loaded onto the ambulance, friend in tow, I climbed aboard to put a line in and give her fluids because her BP was low. Her friend was still misbehaving and was allowed to go to the toilet as we carried out another full set of obs on the patient. This pause seemed to cure her of bad behaviour and when she returned, she was quieter and apologetic.


As I tried to finish the paperwork on that last job, I was asked to go into the club to treat a member of staff who’d collapsed in the toilet. She was slumped on the floor and had been unconscious for a few minutes. She’d been given a drink or two by customers and now she could barely keep her eyes open or make any sense. It looked to me like she’d been slipped something in her alcohol – she certainly wasn’t drunk.

The toilet was like a sauna and I had to wait a fair amount of time before an ambulance came to get this lady out. I was sent another FRU pilot in the meantime and he helped me with obs until we could move her. Meanwhile, I was beginning to drip with sweat.

When the crew arrived and we got her out into the cooler air, she was taken to hospital straight away. If the drugs didn’t get her, the heat of that bunker toilet would.


In the late early hours I was sent south for a 25 year-old man who’d been shot. I passed the armed cops as they suited and tooled up in the street and I arrived to find other police officers pinning a man to the ground as he wept. I was told he was the assailant and that the victim was around the corner - I had no idea why he was crying like a baby. I drove a few metres and pulled up beside another man who was nursing his eye. He’d been hit by a bottle, not a bullet, during a scuffle in the street. He was in a state of shock because he couldn’t believe anyone would hit him like that after a minor disagreement (about what I know not). His injury was minor – he had a laceration above his eye – and he was lucky the other man wasn’t armed, especially in this neck of the woods where real stabbings and shootings take place.


I went home contemplating the random nature of the assaults I’d dealt with. It’s easier to become a victim of violence than ever before simply because there are greater influences on the instigators; drugs, alcohol, theft, anger, social circumstances, territorial jealousy. If someone wants to have a go at you he will and it may well be because you looked at him the wrong way. Of course the Press may not have helped by keeping knife crime in focus because this may have bred a culture of status among those who carry deadly weapons but we still can’t ignore the increase in violence proportionate to the growing discontent of our young in society. We give them little or nothing to aspire to.

Be safe.

Welcome to London

Day shift: Seven calls; four by ambulance; one by car; one left in care; one left with police.

Stats: 1 unknown problem; 1 SOB; 1 fall; 1 ? rib fracture; 1 poisoning; 1 fall with head and hand injury; 1 sleeping person.


Mystery calls can turn into something or nothing, depending on everything.

Before breakfast, a 40 year-old man was found collapse half-in and half-out of the road and police officers were on scene by the time I got there to check on him. He was conscious but making no sense – he kept repeating the same thing; some ‘boys’ had hurt him. He appeared to have no physical injury and he denied drugs or alcohol. His vital signs were normal but he couldn’t keep his eyes open and drifted in and out of sleep.

We managed to get him into the ambulance when it arrived but he remained vague about what had actually happened to him - very strange, although conjecture lends itself to several possibilities given the area he was in, the time of day he was found and the statement he kept repeating.


The man on the park bench complaining of shortness of breath (SOB) and who asked a member of the public to call an ambulance for him was known to me. I picked him up at the weekend and took him to hospital in the car. He recognised me and I asked him what happened at hospital because they wouldn’t have let him wander out and sleep rough if he still had this problem. He admitted that he didn’t let them complete their tests; he didn’t like being ‘prodded’ and ‘treated like a pin-cushion’.

An ambulance arrived for him this time and I handed him over to the crew. He is a non-compliant patient who, if he has a serious health problem, will never get it treated if he continues to run away from hospital after all the trouble we have gone just to get him in there. I explained this to him and he said he understood. Let’s see if he shows up again in a few days.


After a cancelled call for a man who stood on a rusty nail and then thought better of a full-blown 999 emergency response, deciding instead to do the grown-up thing and go to A&E himself, I was sent to assist a 52 year-old disabled man who stumbled down a Post Office step as he exited. The man had very limited use of his legs (they were stumps basically) and got around on a mobility scooter. When he had to move without it he had to go on all fours and 'walk' that way. He had no injuries and a police officer was with him when I arrived. All he needed was help with a major underpants and trousers malfunction – the clothing kept falling down and he was very frustrated about it – he shouted at them as if by magic they’d sort themselves out. Instead, I found myself dressing the man in the street. I suggested braces and he told us he already owned some but didn’t like them. I think, considering he was butt naked in front of women and children in broad daylight, he may want to reconsider his waistband suspension aversion.

His carer came to collect him and I handed the paperwork over to her.


A very pale 38 year-old man sat on the first aid couch with the office first aider, waiting for the ambulance to arrive. He’d fallen from his mountain bike at the weekend and thought nothing of the bashed rib he received. Then, when he came into work this morning he coughed and this produced acute, severe pain, making him feel faint. He was quite off-colour when I saw him and he coughed a few times and certainly seemed to be experiencing pain in one area of his ribcage each time. I listened to it but only heard air going in as normal. There was no ‘bone against bone’ crepitus either but a fractured rib couldn’t be ruled out, so he went to hospital by ambulance.


The next call was for a Polish alcoholic man who’d been taken off a train at a station because he collapsed after drinking stolen spirit gel. He then collapsed again when they tried to make him walk away. So British Transport Police took him to their little office and we were called.

He had two pump-bottles of gel - a hand sanitizer that contains a concentration of alcohol. Some alcoholics mix it with juice to get rid of the taste of the chemical that is supposed to inhibit the drinking of it – they can’t get the real thing or the real thing just isn’t strong enough, so they poison themselves with this stuff. One of my known patients from a few years ago died as a result of continually drinking this. I told the man he could die but he just shrugged and then made a hand-washing gesture. He had filthy hands, so I was reluctant to believe that he carried so much of the stuff because he had a hygiene habit.

A crew turned up and took him to hospital and I went on ahead for two reasons – firstly, the man had over a dozen aliases, according to the police, so I went to see which one he had registered with when he last went to hospital (I found one immediately) and secondly, to give the nurse a heads-up on his habit because they still have lots of these gel bottles around and he was absolutely positively going to steal as many as he could before being discharged... or walking out, which was more likely.


There once were two girls from Vienna... well, anyway, one of them fell down a few concrete steps while touring London (as you do) and got herself a minor head injury, comprising a small cut to the forehead and a painful, swollen, possibly sprained little finger. Two police officers were with her and her friend when I arrived and, after a few bad jokes and an examination, I conveyed them to hospital.

Both girls had very un-Austrian names and both spoke good English. I happen to like Austria; it’s where I go to ski with the family whenever we can (not Harry yet of course). I’ve been to the country five or six times and visited Vienna once. It’s all very pretty in places, especially in the mountains. In fact, if it wasn’t for The Sound of Music, I wouldn’t have believed it was really like that, although I've yet to hear anyone yodelling out there.

I left the two of them in the waiting area. I hope they continued their mini-tour of London without any more mishaps.


A Red2 – ‘unconscious’ turned out to be a street-dweller who was fast asleep on the pavement outside a McDonald’s. She was curled into a ball and looked a bit dead to be honest, so people got a bit panicky and the Manager of the place called an ambulance. To her credit, she did prod the person a few times but there was no response, so I had a go, using my timed-honed LAS person-wakening skills. It took me three seconds to get an arm swung at my face and an abusive response from the person – who turned out to be a woman.

Once I’d got her to see sense, she got up but headed straight into McDonald’s, followed by the Manager and a PCSO she’d asked to help. She didn’t want the vagrant inside her restaurant. The rough sleeping woman was going to use the toilets but, as in any establishment like this, it is up to the Manager to decide who does and does not use the facilities and they preferred not to have her custom.

The woman was ejected under escort and proceeded to shout abuse at a complete stranger who happened to be standing outside. She’d asked her something and the unknown woman had said no. This was followed by ‘You f***ing miserable old cow’. Nice.

Be safe.

Punchbag

Two photo's with one thing in common that really annoys me...can you see what it is?

Day shift: Four calls; one sent packing by police; the rest by ambulance.

Stats: 1 Chest pain; 1 Unwell adult; 1 DIB and 1 eTOH timewaster.

The only call I want to highlight is the last one of the shift. He is a 30 year-old Polish man who pretended to be unconscious in the middle of a very busy street in rush hour. People became concerned and I was called to the scene.

I knew he wasn’t unconscious because we have ways of determining this straight away but he was very good at acting the part and refused to open his eyes or communicate with me for a long time as I knelt beside him being reasonable.

I’d done all the obs I could and found that everything was normal, so I considered using Narcan to eliminate the possibility of a drugs overdose. There wasn’t a hint of an ambulance – no distant siren – so I told the guy what I intended to do if he continued to insist that he was unconscious. He reacted a little by moving his arm towards me and I thought he might be trying to communicate something but it was all a bit random and meant nothing to me.

I’ve seen conditions which mimic ‘unconsciousness’ in that the person is unable to move, speak or do anything of significance to prove they are aware but in every case there was always a way to communicate, even if that meant using eyelid signals. This guy, however, was unconvincing and there was a definite smell of Possum about him…as well as alcohol and stale cigarettes. If this had been a Friday or Saturday night, I would have concerned myself less about the possibility of making a mistake and misdiagnosing what I saw but in the middle of the day, on a crowded street, I couldn’t summon up a reasonable doubt in my head for his behaviour. He was faking it and I knew it.

I didn’t get any further forward with Narcan because using it on him would have been a negligent act – clinically I could no longer support any argument for it because he had reacted to what I’d told him and it was getting clearer by the second that he was staging this, so I tried to reason with him again.

I spent a long time kneeling on that pavement and a hundred or so people must have gone past – a few of them had asked if I needed any help and I politely declined their offers. I got as far as the middle of my second set of obs when he began to feign a seizure; it was a frank and disgraceful insult to anyone who has ever really had one. His limbs stretched and flailed and he made hard contact with my chest and arms several times as I struggled to keep him where he was. I think he was trying to escape by rolling away down the road.

I called Control on my phone as soon as I got a breather and requested an ETA for the ambulance. I also asked for urgent assistance with this man because he started to thrash around once again and this time I couldn’t hang on. The police were requested for me.

Asking for urgent police is something we do with great caution. We are all too busy to be wasting each other’s time and all of us should be able to keep ourselves safe up to a point but the man was getting out of control and his behaviour threatened me, passers-by and himself. I hadn’t yet ascertained whether he had a weapon or not, so I wasn’t prepared to let it go on any longer. Usually I will bear with it until a crew comes to help me out but this time I knew that an ambulance wasn’t coming – it was that time of the day.

A passing man asked if I was okay as he watched me getting bundled to the ground after yet another hit to the chest, this time with feet and I thanked him and said I was okay. I must have looked comically like someone who was in denial. I know I should probably have let go and left him to it but there is always that singular nagging voice telling you this might turn out to be a head injury or epilepsy or something real and that walking away would look really bad to the general public. So I knelt my ground with him until another man approached and identified himself as an off-duty policeman. Now, that was someone I could use to help me.

Between us we held the man still as he continued his pretence and I explained what was going on to the officer. His wife stood nearby with a bemused smile on her face – I think they were out for a lovely day in London town and she probably regretted marrying a copper. He was useful though – a bigger man than me and able to stay calm, as it should be with these things – there’s no point in getting all flustered about it.

Within five minutes the familiar low-growl siren of an armed police unit could be heard and as the car pulled up, the ‘patient’ suddenly came alive. He got himself up instantly. He had recognised that siren and it had scared the life out of him. Now he was cured.

Two cops ran from the vehicle and pulled him towards a wall. They had seen his recovery and they knew what he had been doing because everyone has seen this before. We have a small population of East European men who go around pretending to be unconscious or ill so that they can get a lift to hospital where they will steal alcohol gel and anything else they fancy – that is a fact and it is an embarrassment to every hard working person from that part of the world who lives here. Scotsmen used to have a bad image down here; alcoholic and violent, they would embarrass the rest of us with their behaviour. That doesn’t happen much these days and, in any case, that problem was home-grown – this one is imported.

The man pretended he had no memory of what had happened and stood on the street with the police around him (two more units had arrived). He was told in no uncertain terms that his behaviour and an assault on us was intolerable – they threatened to arrest him for being drunk and disorderly but we all know how much paperwork and time that will waste with the end result being very little or no real punishment, so he was given a long lecture and sent on his way.
I get punched or kicked routinely – a lot of us do, especially in the West End, so we don’t press charges. Instead we fill in a form and it gets recorded (if we even bother to do that). In any case, it’s not the ‘accidental’ clubbing I took from him while he danced on the ground that bothers me, it’s the fact that he knows he can do this and will probably get a free trip to hospital. I wouldn’t feel so bitter about it all if he worked, earned his drink, paid his taxes and contributed somehow to our now fragile and economically unstable little island. That would be nice. Living in the UK is like living in a lovely house you’ve worked hard to pay for and having the extended family over for a visit only to find that they stay permanently, eat you out of house and home and frequently abuse your hospitality. And it’s all okay because we are allowed to go over to their houses and do the same. Emigration looks more and more attractive to me these days.

A Duty Officer arrived as the dust settled, so much as I appreciated the effort, I had already dealt with the incident, with the help of the police.

I took myself off home late and prepared for another very early start. Maybe the next shift wouldn’t be quite so dramatic.

Be safe.

The Dancing Panda

Amy becomes a drip stand and shows her disapproval for time-wasting drunks.

Day shift: Seven calls; one false alarm, two moved on by police and four by ambulance.

Stats: 1 Near-faint; 1 Abdo pain; 1 drug overdose; 3 EtOH.

It was a day of time-wasters and by the end of it I was very annoyed because their antics led to my going home late with an early start the next day. It’s so difficult to smile when you know there’s an hour-long drive and very little sleep ahead of you.

I had an observer with me today. Amy works for us but she's not frontline, although she does come out to watch us getting our hands dirty from time to time. She is a respected face and I get along well with her - she is a lovely person. She enjoys singing and dancing and confessed that she'd like to dress up as a Panda and dance around in costume. This prompted another colleague to reveal that he would like to dress up as a gaurdsman and sit outside Horsegaurd's Parade with a bottle of booze, just to see what they said. The bizarre discussion had me imagining the two of them dressing up and walking hand-in-hand down Oxford Street...just to get a reaction. This conversation, I must add, took place over a coffee when we were on a break. Only coffee was consumed, however.

So, it started with a 50 year-old man who, slumped against a wall in the street, decided he was blind. He was certainly blind drunk and had been pretending to have a fit. I was parked in the middle of the road so that traffic could flow but every time I crossed it I was dodging buses in the bus lane. The ambulance crew had the same obstacle course to run when they picked the man up and took him to the vehicle, where his temperature was taken and couldn’t be read because there was so much ear-wax on the thermometer probe – there’s never an excuse for dirty ears.

He was a thoroughly unpleasant man and frequently swore and spat at us. I believed he was blind because he acted the part well, although I doubted he would be allowed to wander about without a white stick…or a dog. Oh and he claimed he’d been robbed by other street people. Imagine that, his stick and dog stolen by unfeeling homeless thieves. This guy was new to me and, as you know, for the benefit of any doubt I will always allow you to make a fool of me once. So, off he went to hospital.


A 72 year-old man who’d near-fainted at an underground station but was recovering was taken to hospital anyway because he had a cardiac history with a previous heart attack. He also had a low pulse rate and that always arouses suspicion.


Then there’s the story of the stupid 18 year-old girl who created way too much trouble when her friend called an ambulance thinking she’d stopped breathing. The Red1 call had me racing to the hotel and up to the tenth floor, accompanied by panicking staff. She was lying on the bedroom floor doing the ‘I am dead’ act. She had managed to convince the people around her, so her ambition to become the world’s best actress was almost within her grasp but it wasn’t Oscar-winning and that’s what you need to persuade me and my colleagues.

After convincing her that I knew she was faking, I managed to get her to communicate using her eyes because she simply could not…or would not talk to me. So, it was the old one blink for YES and two blinks for NO routine.

‘Have you been drinking?’

One blink

I then turned to her ‘best’ friend. ‘Does she take drugs?’

‘No, never. Absolutely not’.

Back to my winking patient. ‘Have you smoked any drugs today?’

One blink.

I worked on the basis of ‘drugs you can smoke’ and went through the list with her until she blinked once at ‘dope’. Ah-ha! I also think the word was highly appropriate, given her condition and the worry she’d caused.

It took more than ten minutes but I eventually got the whole story from her and her friend. She’d snuck out of the room for a fly smoke, unbeknown to her friend and had reappeared at the door, just to collapse dramatically as soon as her mate opened it. She’s not an experienced druggy and the stuff she inhaled had been given to her by a complete stranger the night before – dangerously naïve.

The crew were not impressed and she was marched downstairs, still not talking, completely spaced out.


I met my blind man again after that. He was curled up asleep in a call box and a MOP had dialled 999 – from an unoccupied box, ironically, when panic set in and he thought the ragged, smelly human being might be dead. Worse still, he might be giving the area a bad name.

I woke him up at arms distance and he launched a verbal attack on me. His eyes, now miraculously able to see, were oozing yellow gel. I can only assume the hospital gave him a prescription for them and he’d squirted it on as if one drop meant the whole tube. The alternative didn’t even bear thinking about.

Eventually a kindly police man happened by, as they do and he offered to take care of the problem for me. All the guy wanted to do was sleep but he was choosing the worst places to be in broad daylight – he really needed to be out of eye and nose range of everyone.


Abdominal pain is taken seriously by us but it an abused symptom, often over-dramatically described and used as a tool for getting into hospital as commonly as chest pain. My 42 year-old Romanian, non-English-speaking patient rolled around on a sofa, half-naked (for reasons I will never understand) in a local tourist hotel, complaining of pain. She had no medical history and played more on it when her friends were around than when they weren’t – always a bit of a clue.


At the end of the day my patience was tested with two calls that were intrinsically linked. The first, to a 50 year-old man ‘unconscious’ in the street, led me to a Polish alcoholic who was feigning epilepsy. He and his mate had been found lying there by local workers but his friend left the scene when I showed up. A couple of wine bottles stood next to him and they were testament to his true state. So, he started with fake epilepsy, which was dreadfully acted out, then he tried to convince me he had a broken leg. He stood, walked and leaned on it, so I guess I was supposed to stop him or something. That didn’t work, so he told me his pregnant wife was in hospital and I should take him, even though it was not the local hospital. Obviously, the local medics had already met him.

Now, before some of you get all hot and bothered, I am NOT racist but our visiting Polish alcoholic friends have a system…they use epilepsy to get into hospital because they think every paramedic is going to fall for it or they think we are somehow duty bound to take them in simply because they shiver a bit on the ground. Most of them have never seen epilepsy and they insult those who genuinely suffer but they have chatted to each other about this and it’s how they get to the alcohol gel; that’s what they want. Wine and beer just doesn’t cut it any more.

I couldn’t convince him to leave the area, so the police were called and he instantly got better when they arrived. That’s another thing; they all know that our uniform means nothing in terms of consequences for their behaviour. The officers moved him along and he practically leaped off on his broken leg…in the opposite direction in which his poor pregnant wife was supposedly languishing in hospital. I feel ashamed that I didn’t provide this man with the medical care and comfort that he so obviously needed at my expense.

Then his mate tries to pull the same stunt further down the road. I was astonished at the gall of him. I guess he thought another ambulance would show up, since I was busy with his friend up the road. He guessed wrong – at that time of day there are few crews available, so I was sent to him and stayed on scene until I was late.

An off-duty A&E nurse and his female friends helped me (they were the ones who'd found him) as I tried to persuade him to stop the act and go away...somewhere else. He was determined, however and I had to go throught the motions because I knew that an ambulance weasn't coming any time soon. I put fluids up in the hope that it would rinse out his blood and wake him up. It certainly made him more alert and he communicated for a short while but not to my benefit and I continued to see the hour slip past, making me even later.

The dancing Panda (she won't mind really) helped me by holding his vital fluids aloft and I flet sorry for her arms, aching as they must have been for the welfare of a man who couldn't care less.

Then he decided he needed another drink and helped himself to more cheap wine from one of his bottles. That was the last straw. I unplugged him from everything and requested police. He had no clinical need of me and had been playing the game he always plays.

Two cops showed up and lifted/dragged him away to another, less public place so that he could act out the final act of his drama...the sleeping drunk with no soul.

Be safe.

Cold heartbeat

This is one of the BTP's explosive search dogs. They each have a card giving their names and details. Apparently these cards are collectable, so I'm going to try and get them all! I have three, the other two dogs are named Pete (#42) and Cookie (who was sacked because he was no use at sniffing for explosives!). Don't you just love the look old Bouncer is giving the photographer?



Have I told you that the worst kind of drunkard is a well-to-do drunkard? Yes? Probably ad nauseum but these people never fail to depress me about the state of society when, compared to a good-old honest alcoholic, they get themselves so wasted that they turn into animals and their attitude and behaviour becomes arrogant and abusive. Historically, as you know, I’ve been sworn at, spat at, punched, kicked and generally insulted by doctors, lawyers, bankers and stockbrokers – people with money, affluence and no good reason to overdo it with the sauce.

This man, a 50 year-old City type, was found at the bottom of escalators at an underground station. He’d fallen. I was asked to attend but by the time I arrived he’d gone – last seen hugging a lamp-post I was told by the staff member who met me.

We managed to locate him harassing a complete stranger in the street. His stance was unbalanced and he looked like he would fall any second if I didn’t get a hold of him. So, I impressed upon him the importance of going to hospital to sober up a little before continuing his long journey home to an entirely different county. He was unimpressed but walked with me to the car.

Our conversation consisted of me trying to advise him that he had no capacity to make a decision about going or not going to hospital and that he was a danger to himself. I explained that he might fall into the busy road and get killed. None of this stuck in his brain and he launched into a verbal nursery rhyme of rubbish information about ‘70’s rock bands. He wasn’t listening at all.

He became a little abusive in his language and claimed he’d had a bag with him. At that point I couldn’t leave the scene with him; I had to ask for police to come and record his claim, otherwise I might get lumbered with the blame for its loss. Witnesses confirmed that he had no bag with him but I needed this written down and so the BTP were called in.

If you are going to get drunk and you are a clever person with degrees and a good career, don’t blow it by becoming an idiot when you drink and more importantly, don’t start giving the police abuse when they try to reason with you about going to hospital for your own safety.

This well-off, well-turned out, intelligent drunkard got himself arrested. He was hand-cuffed in full public view (he tried to fight the cops off) and was taken unceremoniously to the waiting van. He’ll spend a few hours in a cell and dry out. He will certainly regret what he’s done and he will have a record for being drunk and disorderly. I don’t expect his wife will be impressed.


A sudden collapse during a dinner at an hotel (same one as last night!) had a wife, who was a nurse by profession, panicking as she watched her husband falling in and out of consciousness for reasons unknown. The scene was very noisy, with hundreds of people wining and dining themselves and having a good old look at the excitement on the floor. But it was all too dramatic and, although the 30 year-old was diaphoretic and weak, he recovered well on oxygen.

The man had a known fish allergy but he hadn’t eaten fish, so I think he probably reacted to something else. A sudden release of Histamine would do that; increased capillary permeability, drop in blood pressure, possibly leading to collapse and unconsciousness. There was nothing on his ECG to suggest a sinister reason for his drop and his vitals returned to normal within ten minutes of the crew’s arrival. He went to hospital for further checks but I’m sure his wife has nothing to worry about.


Time-wasting individuals with selfish ulterior motives are fairly common in pre-hospital care unfortunately and the next patient, a 35 year-old claiming DIB and ‘can’t move’ was sitting outside a tube station directly across from the hospital when I arrived. He thumped his leg a few times to demonstrate that it was ‘completely dead’ and that he’d need assistance, so I enquired about him at A&E and was told that he had been thrown out twice for drinking their alcohol gel and that he had no clinical need.

I told him what I’d found out and warned him that if he called for an ambulance again it was very likely the police would come and deal with him. He seemed to get my point and I left him sitting where I found him – he will have to hatch another plan if he was going to get what he wanted from the NHS.


Smelly jobs come along every now and again and I’ve had my fair share of them. Tonight the Gods decided I’d get a rancid, putrefying leg in a police station cell. The drug addict had been arrested and was seen by the doctor for an ulcerated leg. He’d been ignoring it and taken none of the antibiotics prescribed for him, so the thing had reddened, become inflamed and a vigorous infection had taken root and was working its way through his flesh to the bone. As soon as I got to the cell door I could smell it; a very strong odour of fish. If he didn’t go to hospital and get it seen to, he would lose his leg.

Of course, he was awkward about it and adamantly refused to go. However, being in custody meant he really didn’t have a choice, so, with the help of a crew, two police officers to guard him and a mask and gloves for everyone concerned, off he went. I can still smell his leg as I write this. I have gone off fish too.


Ending the shift with a bit of drama is guaranteed to wake you up; this is not good if you are kept very late as a result and have another night shift to do later on. Fifteen minutes from going home and a Red1, cardiac arrest is given to me. There is no-one nearer (no paramedic in the area) and the journey will take me north, miles from the station. I know that unless I am cancelled down I am going to be at least an hour late off, possibly more but the call is not for a drunk or an abdo pain, it’s for someone whose life could be saved – it’s a 30 year-old female ‘not breathing at all’, so I raced up to the address and got there just ahead of an ambulance and another FRU; I’m the only paramedic on scene so the onus is on me to run the show, as it were.

The door to the flat was opened by a young child who pointed to the front room and said ‘in there’ as if, at 6.20am, there was no crisis in the place. I would usually be sceptical by this time, thinking that this was a nonsense call but at no point in this run did that cross my mind – it felt genuine from the start.

We bundled into the front room and a woman was straddled over another, carrying out chest compressions using the loud timing ‘beep’ that could be heard over the ‘phone. On the other end of the line was a 999 call-taker who’d calmly and professionally guided the resuscitating woman to this point, and thus began the life-saving process. I went over to the woman and asked her if she was alright, which always seems strange and inappropriate. She nodded and continued but I asked one of my colleagues to take her place and so the well-rehearsed ALS routine began in earnest.

The woman on the floor had last been seen alive the night before and her friend said she’d been making snorting or snoring noises when she breathed. This struck me as strange – if it was true, why didn’t she call an ambulance? A number of other statements seemed out of place but I can’t record them here for pertinent reasons.

There were at least two children wandering in and out of the room as we worked on this young woman and I had to ask a number of times for them to be removed; this is not the kind of thing you want your kids to witness. Resuscitation is a messy, noisy and emotionally traumatic event for anyone to see, let alone a small child.

We had been there for twenty minutes and I was deciding on the exit strategy (we were four floors up and there was no suitable lift). The woman had been asystolic throughout, despite drugs and good CPR, so I really thought we were going to end this with a run to hospital and that it would be called there. But then one of my colleagues said that we had output – a pulse was palpable at the neck. I’d tried Narcan on her, just in case, after asking about drug use. It’s possible this helped to ‘bring her back’. We had no idea how long she’d been in arrest –it could have been all night and her body core temperature (32c) suggested this but the change threw all of us; we really weren’t expecting to get a result.

We continued ventilations and fluids as we struggled with her body all the way down the concrete stairs of the flats and into the ambulance. We connected her to piped oxygen, IV fluids and more drugs as they were needed, then rushed her to hospital, which was less than five minutes away.

At hospital there was genuine disbelief that she had a heartbeat; she was cold and her blood gases were all over the place – she was very acidotic. She was put on a ventilator and I left to do my paperwork and get back to my station. I was two hours late and it took me another hour or so to get home but I didn't really mind because I felt I had done something worthwhile for a change.

When I went back to work later on I was told that the young woman had died. The doctor told me they had struggled to keep her stable and that a drama had unfolded at the hospital when I left and the woman’s family arrived. There is a lot more to this story but I can’t divulge any of the details. It certainly wasn’t a straight-forward job and I expect I will be called upon to relive it.



Be safe.

Dawn of the hand-scrub alcoholics

Nine calls; one cancelled on scene, one false alarm (time waster) and seven by ambulance.

An early start and a call to a 55 year-old male ‘fitting’ on the South Bank. He and his brother were waiting for us – he was lying on a bench going through the act of fitting and his brother explained, in broken English, that they were alcoholics and his brother had been off the booze for a few days, thus the fit. It all seemed well rehearsed to me and my cynical mind was cautious about the next step.

The MRU showed up and did very little except help with my obs; there wasn’t much else to do as the man jerked about on the bench, proving to us how ill he was. I wasn’t buying it and neither was my colleague. Neither did the ambulance crew when they arrived but, with no proof of deceit, he was taken to hospital and his brother wandered off without concern.


Later that day I was called to a 30 year-old male ‘collapsed’ in the City. He had a hospital band around his wrist and the police were on scene attending to him. I recognised him immediately as the ‘fitting’ man’s brother. He’d been in hospital on this side of town and discharged himself. Then he’d feigned collapse to obtain sympathy and another trip to hospital but this time he wasn’t getting it. The crew recognised him too; he was unlucky because he’d managed to draw attention to himself and the people who’d been called – myself and the same ambulance crew as earlier – knew what he was doing. Let me explain...

The man had a bottle of liquid on him and the police made a point of trying to identify what it was. At first it was thought he was carrying alcohol but he wasn’t – he had hospital cleaning fluid on him and he was drinking it. He and his brother had a little scam going; they’d both go to separate hospitals, as many times as possible in a day and steal as much cleaning fluid and hand gel as possible so that they could drink it and glean any alcohol from it. It’s happening more and more and the depth of this fairly new abuse has only just been brought to our attention.

He recovered very quickly when he realised we were on to him and he declined further aid (of course). I referred him to London Street Rescue in the hope that he could be taken off the street but he had a bad record with them and, although they told me they’d visit him to help, I didn’t expect he’d hang around for them. Both men are Lithuanian, neither work or contribute to the country and both are stealing resources openly and without punishment. Can I really be labelled racist for venturing the opinion that we should no longer tolerate such abuse from people we invite into this country for protection and a better life? There are plenty of foreign nationals here who contribute to our society and are part of it – Poles, for example – a few of them are drinkers and we visit them too but at least they are paying for the service!


I was cancelled on an earlier call for a 28 year-old male who fell from his bike when he started convulsing mid-cycle. The crew was on scene and I wasn’t required.


Then a 25 year-old man who was having ‘chest pain’ at a train station. He seemed a bit young for all that and I discovered that he’d actually had a fit and was slowly recovering by the time I got on scene. He was a nice chap (a film producer) and he hadn’t experienced a seizure for some time but was known to have them. He agreed to go to hospital so that they could work out a medical solution for him.


Another fitting person, this time a 30 year-old female, was on the floor of her office and had been convulsing for seven minutes, according to her colleagues. The crew was with me and an MRU arrived too and I got on with giving her diazepam as the oxygen was administered and obs were confirmed. Only after this had been done did her colleagues find out what her condition was; they had a letter stating that she was to be left alone and given nothing because she would recover on her own. On no account, the note said, was an ambulance to be called. Too late for that – they should have looked more closely at it when she gave it to them.


A 60 year-old man who had been arrested for stealing from his employer demanded an ambulance for chest pain and so I was asked to check him out. He told me he had angina and was suffering but he didn’t have his GTN with him and spent most of the time swearing and insulting the police for arresting him when there were ‘real crimes’ taking place out there. He wasn’t at all convincing but he claimed to have a history of MI (although he was vague about the date), so he was treated as genuine and carted off, with a police escort, to hospital.


My second chest pain call was to a shop where a 39 year-old member of staff felt dizzy, had abdo pain (and chest pain) and felt generally unwell. He told me he had a history of this but that nothing had been discovered by his doctors. He went to hospital and hopefully they’ll pinpoint the problem, otherwise he’s destined to go through life suffering.


Multiple Sclerosis is a devastatingly debilitating disease and my next patient, a 25 year-old man, was at home with his family, living with it but now there were other problems and he was vomiting and suffering kidney pains. His concerned mum called an ambulance because, despite putting up with the condition on a day-to-day basis, this was a new development and she feared something more acutely serious had struck.


I was late getting home because my last call took me back into the West End in rush hour. I was going to the aid of a 17 year-old girl who was hyperventilating at a large department store, where ironically, a number of past hyperventilating patients had demanded my attention – maybe it’s a stressful place to work.

It took ten minutes to calm her down and convince her that she wasn’t going to die. Her colleagues were pleased that she was getting better because they had been unable to slow her breathing down and I could hear her from a distance when I first arrived. She insisted on going to hospital ‘just in case it came back’ and I thought she might need to steel herself for life if this was how she generally went about dealing with her concerns. Yes, she’s only seventeen but life is cruel to young, vulnerable and sensitive people. How’s she going to deal with real crises in the future?

Be safe.

Baby bingers

Ten calls; one time waster, one assisted-only and eight by ambulance.

Binge drinking by the under 16’s is on the rise and we are going to more and more calls for 10, 11 and 12 year-old offenders. Now, I know this is a ‘hot topic’ and personally I blame the parents for this too but the main issue is the serious health problems that will ensue if we don’t put a stop to it. We simply don’t know how young livers cope with alcohol in the quantities (and more) that an adult would drink on a binge.

I sat in EOC (our control centre) as I waited to see a friend and listened in on the 999 calls at the HEMS/MRU/CRU desk. As I waited and listened, a call came in for an 11 year-old who’d been found drunk. Later, while out on the road, I heard another FRU pilot say he was going to a 13 year-old drunk. I have personally treated many young drunks over the years and I remember three 13 year-olds unconscious on a park bench after an all-day drinking session. It was broad daylight.

Most of us tried alcohol when we were young, so that’s not the bone of contention; its ease of access and the obvious lack of control of some parents that’s mostly to blame. At 4am, I watched three young girls – probably no older than 12 or 13 years-old – walking past the station on their way to or from God knows where. Are their parents mad? London is a dangerous place for grown-ups at this time of day, never mind kids.

I had an observer – Olivia - out of EOC with me tonight for a few hours. It was good to have her company and we get on well anyway, so she was someone to talk to as well as being a good second pair of hands.

The night started with a 54 year-old man who’d fallen from his mobility scooter earlier and was now complaining of back and abdomen pain. He’d already been seen at hospital and his x-rays were clear but we were called out again because his carer was convinced he was deteriorating. It took a few minutes but, after a full examination, I found out that he was just too scared to stay at home in his vulnerable state. In the recent past he’d been robbed when a gang of youths, male and female, broke into his house while he was inside and threatened him. Nice neighbourhood, I thought, as he tearfully related his story, backed up by his obviously caring carer.

He was taken to hospital but I’m sure his physical problems were exacerbated by his stress. Somebody somewhere needs to do more to protect these people.


I thought the man lying flat on his back at a busy bus stop was in cardiac arrest as I got out of the car and went towards him. The 35 year-old lay motionless after suddenly collapsing in the street. Bystanders were tending to him and as I closed in, I could see that he was breathing, thankfully. I shook him awake in time-honoured fashion because, at close quarters, I could tell he was drunk.

The ambulance crew was on scene at the same time and they arrived to pick him up and take him away, after he’d opened his eyes and admitted drinking a lot.


The address of my next patient seemed almost impossibly elusive. We were in the right place but the numbering of the flats seemed completely illogical and we went up and down stairs for almost five minutes trying to locate the correct door. It wasn’t until Liv separated from me and went to explore another floor (one we’d already been on) that we finally got on scene.The man inside, an 80 year-old with chest pain, wouldn’t have benefitted from this council-planned stupidity if he’d been having a genuine heart attack but, when I eventually got to him, I found that he wasn’t. He had abdominal pain and back pain. His family told me that he’d recently been diagnosed with stomach cancer and that kind of news is bound to give anyone depression - the more I spoke to him the more I was convinced he was suffering psychologically as well as physically.

He’d been ‘jerking about', according to his daughter and he displayed this for me when I got to him but it was more of an emotional reaction to discomfort than anything else and I spoke to him to calm him down. He didn’t do it again after that and lay quietly in his bed as I waited for the ambulance crew who were, coincidentally, trapped outside and as lost as I had been. I had to send Liv to get them.


Then a regular time-waster with ‘DIB’ at a police station. He didn’t have DIB and as soon as I saw him I recognised him...and he recognised me. I’ve known this man for almost five years and have met him many times in different locations. He’s the same guy I wrote about a few months ago; the one who was sitting at a bus stop across the road from the hospital. He has no medical issues but he has psychiatric problems and learning difficulties. He also has a temper and can be aggressive, so I was quiet and calm with him but I still talked to him about wasting our time, especially tonight as it was very busy.

‘Do you want to go to hospital and wait in reception?’ I asked him.

‘How long’s the waiting time?’ he replied. That said it all really. He didn’t want to wait and so I cancelled the ambulance and got the police to call someone and collect him.


A 31 year-old man who’d been beaten up recently had chest pain in Soho. His pain wasn’t cardiac in origin, I was pretty sure of that but he may have sustained damage to his ribs as a result of the beating, so he was taken to hospital.


A short drive to a restaurant in Leicester Square next for a 45 year-old diabetic man who was hypo. Those damned pedicabs were blocking the entrance to the Square, as usual, so I was held up for a few seconds more than I should have been as the restaurant manager waved frantically for me to follow him to the patient.

The man was flat on his back on the floor and his friend explained that he had become unresponsive and fitted just as they were going to have something to eat. I checked his BM and it was 1.8 – far too low. I tried Glucogel but he was difficult to manage, so he got an injection of Glucagon, followed by more gel, which he still wasn’t taking in properly. I was treating him as customers came and went, ate their meals and waitresses busied themselves around us. Liv was valuable to me on that call and she handed me everything I needed, including new gloves because Glucogel is very sticky stuff.

I stayed with him for quite a while until the ambulance arrived (as I said, we were incredibly busy) and by that time, he’d started to make some sense and his BM had improved to 3.4 but he wasn’t completely recovered yet, so he was taken to hospital – prudent considering he’d had a fit – and his condition seemed to be improving just before the ambulance left. Oh and the pizza he and his friend had ordered was delivered to the ambulance door, which I found quite bizarre.


I was on my own for the next call and the rest of the shift – a very tired Liv went home after the diabetic call. A collapsed, drunken female in Soho had to wait because as soon as I got on scene I received a message telling me there was a ‘disturbance in the area’. Sure enough, there were cops all around me and I found myself trapped by their vehicles. Shortly afterwards, a teary-eyed woman was dragged in handcuffs to the lock-up van. She’d been at the receiving end of CS gas and I was asked if I’d check to see that she was ok but the police wouldn’t let do more than actually look through the cage she was sitting in. She was highly emotional but seemed otherwise okay and it was agreed she’d be checked out properly by the Foresnic Medical Examiner (FME) at the police station.

My drunken girl was sitting further down the road with her friends and when I finally got access to the area, I advised her and her friends to get a cab home. She simply wasn’t drunk enough for hospital, which is a twisted irony.


One of the problems I face (as do my colleagues) working on the FRU on busy nights is that I will often spend a long time with patients, sometimes critically ill patients, before an ambulance is available to back me up. Britain’s booze culture is sapping our resources and so, sometimes, you find yourself running out of things to do for a patient while you wait for a free crew. This was the case for my 22 year-old patient who’d suddenly become unconscious in a pub in the East End. A charge nurse from the local hospital had called this in, so I arrived thinking that at least there was one other person inside the establishment who could manage a patient, besides me.

Unfortunately, the nurse was very drunk, very loud and very angry at times. His young friend lay on his side on the pub floor as the manager and bar staff looked on. The place was shut now and the guy had been like this for ‘about an hour’, according to the barman. The barmaid told me he’d had at least five pints but this upset the charge nurse so much that he stood up and launched an angry tirade at her, telling her to ‘shut up’. He told me that the unconscious man had only bought a pint or two. I tried to calm them down because it was getting ridiculous and the nurse had already bitten someone else’s head off for interrupting him as he handed over to me when I first arrived, so it seemed important to me that everyone stayed calm and quiet while I figured out what was wrong with this man. I sensed the delay (sometimes you can just feel it) in getting an ambulance, so I prepared for the long haul.

He was unresponsive, except to deep pain but even then he shut down again after lifting an arm to hit me a few times. He hadn’t taken any drugs and he was a ‘good boy’ who was studying law. I have no idea why that means he’s a good boy and doesn’t do drugs but I took everyone’s word for it and his pupils and breathing rate didn’t say narcotics. So I went for the only possible logical cause (he had no medical history) – booze. He was so drunk, he’d passed out for the duration. His brain had shut down in protest and his liver busied itself trying to rid his blood of excess alcohol. It takes time and his brain wasn’t going to allow him to take in any more while the process was going on.

So, I did all my obs – two or three times and I put a line in and gave him oxygen and fluids. This combination would bring him back to reality soon. I waited for an hour before I saw an ambulance crew – they’d been busy with a shooting earlier, so it was understandable that they weren’t around when I needed them. In any case, the patient was beginning to show signs of recovery and the fluid bolus woke him up as we put him onto the stretcher. By the time he was in the ambulance and I went inside to deliver my handover PRF, he was bright as a pin and laughing at his own jokes, which weren’t funny.

I was thanked by the pub staff and promised that if ever I was up that way I should pop in for free drinks anytime. I resisted the urge to say that I’d seen what the effect of that might be and I mentally declined their kind offer. Anyway, it was pouring with rain and I needed that invitation less than a warm, dry car.


Victoria station is a regular call hot-spot because lots of people get drunk and attempt to get buses home from there. My 28 year-old patient sat in a bus shelter, supported by a small group of men who’d stopped to help him when he fell flat on his face into a puddle, cutting his head open. They propped him up and held his head for him because he couldn’t do it himself, thanks to either alcohol or the head injury...or both. I think both.

Initially he was unresponsive and kept slipping down from the seat he was on. I didn’t want to lie him down in the rain, so I got the posse to continue their sterling work as I put him on oxygen and dressed his wound. The bleeding had stopped and he had a decent gash to his forehead but I knew he’d live to drink again.

The crew arrived and he was wide awake. It had been a twenty minute wait this time, so not too bad and I had everything I needed for a quick handover.


A man was seriously injured later on when he was set upon by a gang and hit about the head with fists, feet and chains. The police were on scene when I arrived and he sat in the doorway with them. His cheek bone and the orbit of his eye were both obviously fractured and his eye stood out from his head like a golf ball. He was a large famed man; about 6 feet 4 inches tall and he easily outweighed me and the police officers around him. Head injuries can produce violent behaviour, especially when combined with alcohol, so we were all very aware of the potential this guy had for damaging us, especially me as I was up front.

He thrashed about a few times and tried to rip the oxygen mask off but he was manageable and I waited no more than fifteen minutes before an ambulance pulled up and helped him to his wobbly feet. I’d dressed his wound and examined him for other injuries, especially to the neck, chest and abdomen, which may have been caused by a weapon (it’s easy to miss a stab wound when you focus on a head injury). He had no other injuries and he’ll recover in time from this one but he may need some reconstructive work done on his face.


I went home on time and the night seemed to have flown in fairly quickly, as busy ones do. The weather was miserable but I was happy enough because I’d done a few good things and had a helping hand and good company for a few hours to boot – it can be lonely out there.

Be safe.

Too Scottish

Fourteen emergency calls; two assisted-only and twelve went by ambulance.

I was very tired when I started this long, busy shift and I was sent immediately I booked on-duty to a 58 year-old with renal failure whose family suspected he’d suffered a TIA after a day trip to the seaside. They ran around the estate guiding me in, which was just as well because the place is a nightmare to navigate around.

He sat in his wheelchair outside in the sunshine and explained that he didn’t feel well. There was no evidence of a new brain insult but he was taken to hospital for checks anyway when the crew arrived a few minutes into my primary.


I encountered my regular Lithuanian gel-stealing friend when a call came in for a 28 year-old male who’d had a '? fit' after being assaulted by bar staff. This turned out to be false; he hadn’t been assaulted by anyone and he wasn’t fitting, although he tried his best, as usual, to put on a good show. The MRU was already on scene and I advise him and the crew, when they arrived, of what I knew of this man and his brother. Both are alcoholics who feign illness to get into various hospitals throughout the day, only to leave laden with spirit gel before they have been assessed. It’s a disgusting betrayal of the trust we show to visitors and those seeking to live in this country – it’s also has a shameful tarnishing effect on the majority of those who come here for honest purposes.


A young man lay face down on a tube platform, perfectly drunk. It took me ten minutes to bring him back to a level of sobriety that would ensure he could get home on his own without tying up an A&E bed. The crew and I walked him to another platform and bid him farewell. He looked appropriately ashamed of himself.


When a bus hits you in the West End, you’ll get a big response from us. Two MRU’s, an ambulance, police and myself were deployed to a minor injury after a 25 year-old female was dealt a glancing blow by a bendy bus. She was collared and boarded just in case and off she went to hospital…just in case. Oxford Street was closed off in both directions as we assessed and treated her, so there weren’t many happy drivers around us.


I wasn’t required for the 44 year-old female with chest pain at a theatre; the crew was on scene when I arrived.


During a routine fuel fill-up at one of our designated petrol stations, I said hello to Graham Norton, who was busily filling his Lexus. I’ve met him before and he’s pleasant enough. I was behind his vehicle (not intentionally) as I travelled back to my area and he mounted the pavement to let me pass when I received my next call and switched on the lights and sirens. Nice to know I could change the balance of power for a few seconds.


GHB is a common recreational drug, especially among members of the homosexual society and it produces complications that can lead to death. Most of the time, however, we are trying to manage an unconscious or semi-conscious and combative person. My next patient, a 25 year-old man whose partner had called us, was no exception. He’d been given the drug by a stranger in the toilets of a Soho club and had collapsed in the street afterwards. Now he was a thrashing, kicking individual with no sense of where he was or what he was doing. The streets were very busy, so as soon as the crew arrived, we got him onto a trolley bed and into the ambulance, where I left him.


We were short of a few ambulances tonight and I was asked to make a very long journey north, well out of my area, for a 44 year-old female with chest pain. I couldn’t find the address after my slog and the crew were on scene a few seconds after I’d managed to locate it and been greeted by the patient, who’d walked herself down stairs to open the door for me. I handed over straight away and made my way back because there was a hole in the cover in my own area now.


I suspect I was sent to the next call because of my origins; a 51 year-old man was complaining of back and abdominal pains but was ‘very difficult to understand due to a very strong Scottish accent’. I guessed I was going there as a medic-interpreter!

I stood outside his secure entry door with the crew but he wouldn’t buzz us in and refused to come and meet us, according to Control when I called in. Ten minutes later he appeared from a completely different direction and we realised we’d been standing at the wrong door all along. I blame the council planning people personally.

He wasn’t friendly and yes, he was Scottish, Glaswegian like myself but he was quite easy to understand, so I let the crew get on with it and did my paperwork. I’ve met this man before and he can become very aggressive. The crew knew of him too and they spent a long time inside his flat. Concern evaporated when I realised they were probably trying to talk him out of going to hospital because he didn’t need to.


A 22 year-old woman walked across a busy road against the traffic lights and got hit by a car for her trouble. She’d been drinking and admitted this to me when I found her sitting in a police car. She had no significant injury and I discovered that the car’s mirror had struck her at low speed. She was still collared and boarded because she couldn’t remember much of the event and this might have been a result of her alcohol intake or unconsciousness after the collision. Neither the crew nor I were taking any chances.


My next patient didn’t like the fact that I woke him from his drunken sleep and he swore at me as he headed off down the street. The 26 year-old man had been found ‘unconscious’ in the street by a worried MOP. I shook the man awake and he found me instantly objectionable; it’s a hard life.


I left the crew to deal with a 25 year-old female who was fitting at a bus stop because I was excess to requirements and was sure I’d be needed elsewhere. I soon discovered I was when I was sent to a 35 year-old man who was ‘unconscious’ on the top deck of a bus.

The dreadlocked six footer was face down and in a very tight space but was easily roused and I sent him packing with the reassuring words that ‘everyone falls asleep on warm buses when they’ve had a drink’. He seemed to understand.


A confusing call for a 25 year-old male ‘unconscious’ in an alley turned into a redirected call for a male with a head injury after a fruitless search for my patient. The call had been made twice but with different details given, generating a duplicate. The crew was already on scene and dealing with a guy who’d been assaulted.


My last call almost ended with a young woman exercising her right to refuse treatment, even though she complained of chest pain. I found her in a doorway with friends; she seemed intelligent and probably articulate but I didn’t find any of that out until later because she wouldn’t make eye contact with me (which always makes me suspicious) and she wouldn’t talk to me. She did, however, hug up to her friend a lot and speak to him every now and then. There’s nothing more frustrating than being called out and having to pry information from an obstructive patient.

The crew arrived and, just as we were going to leave her after she refused for the nth time, she conceded and went to hospital. She was obviously stressed and something happened that I’ve seen a lot – once her friends were out of the immediate area, she opened up. She even smiled a few times for me.

At hospital we waited to book her in and I spoke to her about what could be troubling her and leading to these chest pains, which she’d had before. I discovered she’d been having a lot of problems at work and stress had been dominating her life recently.

‘Are you staying?’ she asked me.

‘Do you want me to?’ I replied.

‘Yes’.

And so I chatted with her until I’d been at hospital almost long enough to generate a ‘phone call from Control asking where I was. It’s been a while since I’ve spent more than a short time with any of my patients and it softened me.

Be safe.

Runaway

Five emergencies – one left scene, one conveyed in the car and the others by ambulance.

I didn’t do a thing until almost 11pm. It’s unusual and I’m not complaining about the rest but unfortunately, the quiet period couldn’t have been predicted, so I never quite knew when a call would be coming in – thus no possibility of actually recharging my batteries.

When the first call came in, I was sent to the City for a 25 year-old man who was unconscious in the street. I was expecting to find a drunk asleep on the ground but when I arrived, the man was sitting up and there was someone with him – the person who had made the call. As I approached the patient, I heard the caller telling Control that I was there now. Then he hung up and walked away, without a word. I thanked him and got a weak wave as he walked off, leaving me with the patient.

I had to assume that he had been found collapsed in the street because the call description stated that he had been in and out of consciousness. He was sitting up now but he wasn’t with it at all. Every attempt I made to communicate and ask simple questions like ‘what’s your name?’ was met with a look in my general direction, an ‘uh?’ and a quick drop of the head. I asked him if he’d been drinking; there was a powerful smell of alcohol and urine or a mixture of those and faeces – I couldn’t quite make it out because the aroma was fused. Whatever it was, I found it offensive when I got close. His response to the question was to nod. I took that as a yes.

Then I asked him if he was a diabetic because his behaviour just didn’t fit with simple inebriation somehow. He nodded his head to that too. I checked his BM and it was marginally low; not critically but enough for me to consider that it was dropping, so I got the Glucose gel out and tried to get him to eat some but he spat it out immediately. I was in the middle of the pavement alone with this guy and people were beginning to hover around to see what was going on. I got no help, however.

I got my bag out of the car and by the time I got back to him, he was unconscious. I gave him an injection of Glucagon, which was awkward as I had to hold him and try to work around his heavily sleeved arm to do it. Still, even though they could see my struggle on this freezing night, nobody offered to help. I considered asking the nearest nosey person to me for assistance while I continued my treatment but I thought I’d best just get on with it.

Then two police officers showed up and I got the manpower I needed. The patient was still unconscious and I needed to get him out of the cold. There was no ambulance available for me and I didn’t know how long I would be waiting for one. After a thorough examination, I had the patient lifted into the back seat of the car and I thought seriously about taking him directly to hospital rather than wait but Control advised me that an ambulance was finally on its way.

Meanwhile, the man was waking up a little but he still didn’t make any sense. I thought about the possibility of drugs and checked his pupils; they were pinpoint. He wasn’t just drunk – I couldn’t believe that was all there was to this, so as soon as the ambulance arrived and we got him in the back, we checked everything again. He was mildly hypothermic, he was becoming unconscious again, his pulse was slowing and his BP was low. He had no injuries, so his condition was a mystery. I gave him narcan and put fluids up to stabilise his BP. We got him rapidly to hospital and by the time he was in Resus, he was more alert but still not making sense. He may well have taken some other kind of drug (narcan only works on opioids) because the answers to the questions posed by the nurse were childish.

‘Where do you live?’ she asked.

‘Mars’, he said

‘How old are you?’

‘12’

Said it all really. I wonder if he’s been at the chocolate?

I didn’t get called out again until the early hours of the morning. I had spent almost two hours with the last patient and I got back to the station for a break. Now I was off to Camden to help a 42 year-old female who had called us from a public telephone. She had a personality disorder (which wasn’t specified) and was complaining of chest pain. Unfortunately I couldn’t help her because she abandoned the call box when I arrived on scene. I saw her in the middle of the road during an area search – she waved at me in a ‘hello, I’m here’ sort of fashion, then took off with a couple of dodgy looking blokes. She wasn’t interested in going to hospital anymore. My guess is, she had scored what she was after all along.

When the clubs started chucking people out, at around 4am, I got a call for a 20 year-old female who was drunk and couldn’t stand up – this, I thought, was the very reason for drinking in excess. I helped her get to her feet and she promptly collapsed again, wailing about her condition. The crew had to lift her onto the trolley bed and baby-sit her all the way to hospital.

An 80 year-old female with a history of CVA fell onto her bathroom floor and split her scalp open. It wasn’t serious but it would need to be closed properly to prevent infection. There was also the possibility that it wasn’t a simple mechanical trip and fall, so that too needed to be investigated, although she looked and sounded perfectly well. She had a roaring log fire on and it seemed a shame to have to leave when the crew arrived. I went back out into the cold morning and headed to my base station in the hope that I would get home on time.

Nope.

A last minute call for which there were no other resources except me, apparently. A 13 year-old boy who had been hit by a car the day before had been found collapsed in the street complaining of a sore head. As soon as I read this I didn’t believe it. I got on scene within a few minutes and there were two people with the young lad; an off-duty police officer and a female passer-by. He had been slumped against a wall when the officer, who had just stepped off a bus on his way to work, came across him with the woman. He had told them that he had passed out last night after being hit by a car. He repeated this to me, regardless of the fact that I wasn’t asking him about that anymore.

‘What are you doing here at this time in the morning?’ I asked him again and again.

‘Last night I got hit by a car. I passed out’, he mumbled over and over.

‘Yes but that doesn’t make sense, does it?’ I said repeatedly.

I told the police officer that I was suspicious. I pointed out that if he’d been hit by a car, he would have spent at least last night in hospital, so why was he wandering around at this early hour with a bag? It didn’t work for me at all and I could tell by the way he avoided direct questions that something else was going on, so I requested the police to scene.

I continued to ask the boy what he was doing there and he insisted he had been hit (now it was a glancing blow) by a car, had wandered off and passed out on a park bench, where he had been all night. Again, I didn’t believe him. He didn’t have a mark on him and unless the driver of the alleged offending vehicle was a criminal, he would have stopped and tried to help. This wasn’t the first time I had come across this excuse from a young boy in trouble; I’ve posted before on the subject.

When the police arrived, I explained the situation but the mystery was about to be solved; the officers had been looking for him all night – he had been reported missing by his mother after they had argued and he’d stormed out of the house. He’d obviously wandered around all night and needed an excuse to get back home without incurring the wrath of the authorities and his parents. I understood this thought process because I’ve done it myself when I’ve run away from home as a youngster. It’s difficult to just go home – you need a buffer so that you can be accepted again without consequences for the worry you’ve caused, so being hit by a car and passing out (therefore not your fault) seems to be the popular choice these days.

I took him to hospital with a police officer as his chaperone and I booked him in to the children’s A&E where he’d be safe and await his mother.

This young boy played a dangerous game. He spent the night wandering around, making himself vulnerable and easy prey for some of the worst people that exist in those dark hours. If he’d spent the night on a park bench, as he’d stated, he had put himself in even more danger but it was freezing overnight, so I think it’s more likely he found a quiet, well-hidden doorway to crawl into for the night. He must have been lonely and terrified.

Be safe.