The Last Post (of 2007)

Six emergency calls. One assist-only and five required an ambulance.

I saw this cactus in Homebase and felt very sorry for it...so I bought it and took it home, away from the laughing mockery of all those who saw little of it's character beyond appearances :-)

A nice easy-paced day, starting with a 78 year-old woman who fell down her stairs at home yesterday, bruising her head and face. She had suffered a fit today and her worried relatives called an ambulance. A wise move I think.

I found her tucked up in bed when I arrived. She was fairly alert but her face was mottled with blue and yellow (the elderly tend to look much worse for wear after a bump or fall). She seemed unconcerned about her condition, however.

‘Would you like us to take you to hospital?’ asked my colleague (the ambulance crew arrived pretty much at the same time as me).

‘Do you really think that’s necessary?’ she replied.

Like I said, unconcerned. Off she went nevertheless; a stoical old lady with a likely head injury and potential internal bleeding.

My next patient was older – 97 years-old to be precise. She was sitting at her dining table, her son and daughter-in-law by her side. She had ‘gone funny’ just after her meal. Her behaviour was abnormal and she seemed to be very weak. She had vomited several times and I could smell that from her when I began my obs. She had a pale, lost look about her and I believe she had suffered a stroke.

This call brought me down from the West End to my base station, literally on the doorstep of HQ. There were no ambulances available at the station or nearby, so the crew arrived from even further afield – Islington! Don’t think you are guaranteed an instant response just because you live next to an ambulance station...quite the opposite in fact; we are often out and about or being dragged far, far away.

FRED was doing interesting things too. The system sent me up to Islington for that earlier job and sent my FRU colleague from that area into MY patch. Kind of doesn’t make any logistical sense, does it? I am told FRED will be switched off during New Year’s Eve...now there’s a vote of confidence.

Another local job next - a Somalian woman who became ill as soon as she stepped off the plane from Africa. She had gone over there for a few months and had come home vomiting, shivering and lethargic. She coughed in my direction several times until I asked her not to (I had to have that translated because she spoke no English). I have a cough of my own at the moment and the last thing I need is a possible tropical disease.

After a few questions and a few more tests I discovered that she was diabetic and that she had taken her insulin over to Africa but had come home without it. So, she hadn’t taken her meds for a few days now...her BM confirmed that, it was quite high. She had brought this on herself. The cough was a separate problem I think but I still wasn't allowing her to cough in my face.

A long drive into the south and I found myself at the address of a very well known time-waster. I have written many times about him and he has had visits from our Officers to try and dissuade him from calling us unnecessarily. Nothing has worked and he doesn’t care.

When the call came in I set off but didn’t pay much attention to the name or the address until I got into the area and immediately recognised the street. All I had to do then was confirm that he wasn’t actually dying. He never is.

‘So, what’s the problem today?’ I asked him as he lumbered down his stairs to meet me. I felt like a taxi driver or chauffeur.

‘Oh, I’m ill mate. I’m not well at all. I have pain in me guts.’ He replied, sitting down on the last step at my request.

‘Does the pain go anywhere else?’

He pointed to his back and the rest of his abdomen. I was testing him because the call description stated that he had chest pain, thus the emergency response. It said nothing of abdominal or back pain. Or a pain in the neck for that matter...

‘Is that it? No other pain?’ I asked him.

He sussed me and pointed warily to his chest.

‘Oh, and a pain in here too, mate.’

I ‘aint your mate, I thought.

The ambulance arrived soon enough and I apologised to the crew in advance but it was unnecessary because they knew him too. Still, he said he had chest pain and we can’t ignore that, so he went to hospital. I know he’s lonely and I know he is old but he is aware of what he’s doing and one day it will cost him dearly. Crying wolf with the ambulance service will always cost you in the end.

I drove back into the West End and got called to a 20 year-old female who had fainted in a store. She had never fainted before and seemed to be recovering well when I got there but she still felt a bit sick. I asked her the usual question about pregnancy and she was pretty sure she couldn’t be. I often wonder how sure women are when they tell me that. It was best she went to hospital and so I waited for the ambulance to take her away and had a smile and a joke with her until it did.

On my way back to base, I got called to a 20 year-old female at an underground station who was ‘anaemic’. I thought this must be a joke – an emergency call for a common medical complaint? I asked Control to hold fire on the ambulance until I had checked it out. It was that time of the day; ambulances would be thin on the ground until the shift changes were complete and I knew how Control sometimes struggled to get vehicles to calls at this hour.

On my way, the job was cancelled then reinstated. Then I got a call on my ‘phone and the voice at the other end said

‘I cancelled you on this because you only have fifteen minutes left of your shift. I thought it might be a waste of time for you but it’s up to you if you want to do it’.

It was very nice of her to do that. I was only half a mile from base and could easily have turned around and got home on time. I didn’t, however. I also thought ‘what if this is not as given?’

‘It’s alright, I’ll carry on and see what’s what’, I offered.

I got there to find a young Asian girl with her boyfriend and a few other lads sitting in the ticket hall. A member of staff had called us because she had felt a bit faint on the train. Now that she was in the fresh air, she felt much better and was quite happy for me to cancel the ambulance. Her anaemia had nothing to do with this current little crisis. I think the staff thought they should mention something that sounded vaguely important so that an ambulance would come quicker. I think it’s high time a training course was organised for the public sector. I’d call it ‘when NOT to call an ambulance’. Fifty quid per head. Lunch provided. Payment in advance.

I got home late but I’m brave.

HAPPY NEW YEAR TO YOU ALL!! I’ll be out and about, picking up your drunk, semi-lifeless bodies on New Year’s Day night, if you see what I mean. Then I am on extended leave. Have a good New Year and please try to drink sensibly. That means, as soon as the world starts to make sense and the ugliest woman you have ever met shape-shifts into a vision of beauty...STOP!!!

Be safe.

Last Christmas

Eight emergency calls. One dead on scene, the others went by ambulance.

I thought my first call of the shift was going to be a suspended patient. It was for a 37 year-old male with ‘blood coming from mouth, not waking up’. I asked Control if an ambulance was on its way because I had literally just got into work and had virtually no time to complete my checks.

‘If this is a suspended, I’ll need a crew there as soon as possible’, I said.

Somehow, this became translated as ‘the patient is now suspended’ because that’s the message the ambulance crew received on their MDT moments later. The communication problem was exacerbated even further when I got on scene, couldn’t find the exact address (it was one of those streets where the numbers, both odd and even, were spread randomly around), and called Control for a more precise location. Unfortunately nobody answered my call and as I poodled around looking for the house, a woman waved at me from her doorstep. By the time Control had got back to me I was out of the car and in the house, so the ‘nothing heard’ message would probably have confirmed the fact that, to them, the patient was suspended.

He wasn’t, however. The woman led me to the basement bedroom and pointed him out.

‘I tried and tried to wake him but he won’t respond at all’, she told me.

I called his name once and he opened his eyes.

There was a little blood stained saliva on the pillow next to him and he was certainly very confused looking. I think he might have had a fit and bitten his tongue in the process. Even though he had no history of epilepsy, something neurological had happened here.

He was difficult to work with initially because he was still post ictal, so he didn’t comply with my attempt to get obs and he couldn’t answer questions properly. He didn’t know where he was or who his wife was at first but after five minutes he began to recognize her. By the time my colleagues arrived (weighed down with everything they needed for a resus), he was recovering.

We got his wife to dress him and he brought himself upstairs to the waiting ambulance. He was back to his normal self, according to his spouse. He certainly looked a whole lot better than when I first saw him.

I can understand her fear when she heard him gasp for air and then couldn’t wake him up. He needs to be checked out to discover what might have taken place and to prevent the possibility of a more serious episode later on.

I was sent to Hyde Park Corner for the next call, a 30 year-old man with a head injury after falling, but the location was wrong. I should have been at Speaker’s Corner, which is at the other end of Park Lane. The ambulance was with me at the wrong place too and we carried out an area search before the correct location was given. I think a tourist had called it in, thus the confusion. Luckily, despite our delay of ten minutes or more, the man only had a minor bump and cut after slipping on wet stairs.

I arrived with the crew from the Speaker’s Corner job at the next call – a 60 year-old man with heart problems. I recognised him when I went into the restaurant where he was sitting with my colleagues. He had genuine cardiac problems but I vaguely remembered taking him to hospital and he was discharged very soon afterwards – nothing was wrong with him. Still, this wasn’t my call, so I pointed out the fact that his face rang a bell and left the crew to get on with it. They blued him in after looking at his ECG – apparently it was problematic.

On my way back to the station I was called to an 80 year-old who was fitting on a bus. He had collapsed suddenly outside and his friend and other bystanders had hauled him onto the floor of the bus for his own safety when he started to have a seizure. Not something I would recommend but I guess they were reacting instinctively. The man was breathing abnormally when I got to him. He was clearly having some kind of neuro event.

The crew arrived within a few minutes and I was preparing to insert an OP airway (he was on oxygen now). There was now enough of us to stabilise him properly. I couldn’t open his mouth because his jaw was clenched shut, so we kept things basic – oxygen and IV access; the latter proved difficult because he became very combative. Now all we had to do was plan a way off the bus.

We had no choice but to support him and ‘walk’ him off the lower deck and onto the waiting trolley bed. Then we got him into the ambulance. Within a few minutes and just as the crew was about to leave, he had another seizure. He became stiff and his breathing stopped for at least a minute. His back arched and his jaw clenched even tighter than before. It took a shot of diazepam to get him to settle down again. Epilepsy wasn’t being ruled out here, regardless of his negative medical history and the drug would calm him down enough to restore breathing and make him easier to manage en route to hospital.

Once he was settled again, I left the crew alone and the patient was ‘blued in’ to hospital.

A quick rest at the station then a call to a 45 year-old man with chest pain and DIB. He actually had abdominal pain and had taken Gaviscon, thinking it would go away but it didn’t. He wasn’t the type to complain easily and it was the staff at his workplace that had insisted on calling an ambulance, otherwise he would probably have continued taking Gaviscon until he died of a heart attack, if indeed that was what was going on. His ECG was abnormal and he didn’t look very well, so I would be reluctant to second-guess this one. He went to hospital on that basis.

Then a 36 year-old female ‘in and out of counsciousness’ who had fainted at a tube station. She was recovering when I arrived, although once again the sales crowds had slowed me down and it took me longer than usual to get to her. The crew took over after five minutes and I left them with her.

In the early evening I got a call out of my area for a 51 year-old male ‘not breathing’. My MDT crashed just as I took the call but I navigated my own way there while it re-booted. None of the details were available to me until I was near the scene. I read the screen and it stated ‘caller believes patient is beyond help’. This usually means they have been dead for a long time. Death is obvious to everyone in some cases.

A neighbour had called the police to the man’s flat because she hadn’t seen him since Christmas Day. She couldn’t get an answer when she hammered on his door either, so the police broke in and he was found dead in his toilet. I walked in to find the crew just coming out of the room. I went in to see for myself and it was indeed an obvious death. He was folded over on his knees, head on the floor. He had just gone to the loo by the look of things and had suddenly toppled onto the floor dead. The blood from his mouth was dark and smelled bad, so he probably died from ruptured gastric varices. It’s common enough for those with liver disease, especially as a result of alcoholism. Indeed, the patient’s front room seemed to bear his dependency out – there were lager cans strewn around and very little else. Absolutely no food in the fridge.

I left the scene and the crew stayed behind to complete the paperwork. A small group of neighbours and curious residents had gathered near the flat to see what was happening. Inside, an alcoholic man with no food and two televisions had seen his last Christmas.

A final call to the police office on Piccadilly Circus for a 7 year-old boy who had fainted. Highly unusual at that age, I thought. Surely the age had been misheard?

When I got there I found a family and a sick young boy waiting for me. He was eleven, not seven. Still unusual though.

He was complaining of abdominal pain and had suffered this for a while. His GP had checked him and tested him for the possibility of appendicitis but this proved not to be the case. So, he was told it was just cramps and that was that. The fact that he had collapsed several times as a result of the pain hadn’t been enough to warrant a more thorough investigation of the cause and now here he was, hundreds of miles from home with his family in London, passing out in the street.

He was very pale and lethargic and his pain seemed confined mainly to his right lower abdomen (thus the appendix link) but I wasn’t going to postulate because only two thirds of children suspected of having appendicitis actually do. Clearly his GP knew this and hadn’t made a decision about it. The trouble was that his acute condition might develop into a life-threatening emergency at any time.

The crew took him and his mum to hospital and I followed with his dad and brother in the car. That took me close enough to my base station for me to get home on time, which, I hope you understand, is an important thing for me to achieve after a shift like this.

Be safe.

Bits and pieces

Here's a couple of things that were emailed to me. I thought I'd post them for your interest.

This was sent to me by my friend clairey:

Being British is about...

Driving in a German car to an Irish pub for a Belgian beer, then grabbing an Indian curry or a Turkish kebab on the way home, to sit on Swedish furniture and watch American shows on a Japanese TV. And the most British thing of all? Suspicion of all things foreign!

Only in Britain can a pizza get to your house faster than an ambulance. (I remembered this with a smile when I arrived at the lift of a patient's block of flats and a pizza delivery guy stepped out before I got in!)

Only in Britain do supermarkets make sick people walk all the way to the back of the shop to get their prescriptions while healthy people can buy cigarettes at the front.

Only in Britain do people order double cheeseburgers, large fries and a DIET coke.

Only in Britain do banks leave both doors open and chain the pens to the counters.

Only in Britain do we leave cars worth thousands of pounds on the drive and lock our junk and cheap lawn mower in the garage.

Only in Britain do we use answering machines to screen calls and then have call waiting so we won't miss a call from someone we didn't want to talk to in the first place.

Only in Britain are there disabled parking places in front of a skating rink.

NOT TO MENTION..

3 Brits die each year testing if a 9v battery works on their tongue.

142 Brits were injured in 1999 by not removing all pins from new shirts.

58 Brits are injured each year by using sharp knives instead of screwdrivers.

31 Brits have died since 1996 by watering their Christmas tree while the fairy lights were plugged in.

19 Brits have died in the last 3 years believing that Christmas decorations were chocolate.

British Hospitals reported 4 broken arms last year after Xmas cracker-pulling accidents.

18 Brits had serious burns in 2000 trying on a new jumper with a lit cigarette in their mouth.

A massive 543 Brits were admitted to A & E in the last two years after trying to open bottles of beer with their teeth.

5 Brits were injured last year in accidents involving out-of-control Scalextric cars.

And finally... In 2000 eight Brits were admitted to hospital with fractured skulls incurred whilst throwing up into the toilet.



An Aussie ambo friend sent me this link to read:

http://www.theage.com.au/articles/2007/12/22/1198175413377.html


Xf

Madness

Six emergencies. One time-waster.

We have become an ugly consumer society, hell-bent on spending every last penny (that we don’t have) on price-reduced items we probably don’t need. Our credit cards allow us interest-free debt and the banks know – they just know – that a large percentage of us will never be able to recover the five grand limit they gave us in time and that they will earn a hefty 15% profit from our stupidity and greed.

Welcome to the Christmas sales.

I joked with my colleagues that we should have a couple of vehicles on standby in Oxford Street but later on in the day the joke would be on us. I got in at 6.15am, started rolling at 6.30 and all was quiet for the first few hours of the shift.

My first job was to a 46 year-old female who had called from a women’s hostel. The reason for an ambulance had not been given, so I was sent to investigate. I arrived to find a confused staff and manager; they had no idea that an ambulance had been called and it was strict policy, according to the boss-lady, that all guests go through the main reception if they wanted one. This kind of confused me because I could see where it wouldn’t be practical: I wouldn’t want to mess around going through other channels during my heart attack when I had a perfectly good mobile phone with me. On the other hand, it was good news for us because it meant calls like this wouldn’t (or shouldn’t) happen.

Eventually, after a ten minute wait, the culprit was found and I was taken to her.

‘Do you want to talk to her alone?’ the good intentioned hostel manager asked.

Hmm...women’s hostel. Beaten women, abused women, drug addicts, alcoholics, frightened women...

‘No, I think it would be better if there was at least one member of staff with me at all times’, I replied.

My patient had nothing wrong with her. She was instantly defensive and swore a lot during our conversation. I asked her why she thought she needed an ambulance and she had no answer. Then she decided she had a valid reason.

‘I have cracked ribs. I need some sort of pain relief.’

The hostel manager gave me a ‘I know nothing of this’ look.

‘So you want to go to hospital?’ I asked.

‘No, I f**king don’t. I want YOU to give me something for the pain and then you can go.’

I felt needed.

‘Well, I won’t be doing that because I don’t just dispense pain relief and leave the patient behind.’

At that she decided I was no longer useful. I think she was disappointed that a man had shown up for her in the first place. To be honest I would have preferred to leave her to a couple of my female colleagues – she had an obvious hatred of my gender.

I left her to the staff and went back to my station. It would be a couple of hours before I went to my next call but I didn’t stay at the station – I was sent on standby. The hierarchy in Control don’t like it when I am sitting down with my colleagues for too long. Instead I have to go out, patrol around and sit in the car watching the empty streets.

My next call was a 20 year-old woman who complained of blood in her urine. She was in a hotel room with her boyfriend and had gone to the loo and noticed a few spots of blood in her pee. She pointed it out to me when I arrived but I couldn’t see anything untoward in the pan. Her boyfriend kept a concerned distance. Young men tend to do that when their partners have a medical crisis – especially one of this nature.

‘When is your period due?’ I asked.

‘Now. It’s a week late’, she said.

‘Oh’, I thought.

She had a little abdominal pain too, so she may have experienced implantation bleeding. The crew arrived and she was taken to hospital for further checks.

I had no idea how busy it had become in Oxford Street and the surrounding area during my first four or five hours on duty. Generally, the streets had been quiet and the traffic light, so working was fairly stress-free. Then I got called out from my station for an 18 year-old who had been stabbed in the chest in one of the large department stores.

I got to the Regent Street end of Oxford Street and was probably no more than 300 metres from the scene when I hit immobile traffic and thousands of people. There were so many bargain hunters on the street that they spilled onto the road, making progress for vehicles very slow indeed. Bendy buses make things even worse because they take up so much room, length-wise that by the time I get to the end of one, another has pulled out in front of me and the distance I had covered becomes nonsense. A police car joined me at the front but it too became obstructed, regardless of the light and noise we were both generating we were going nowhere fast. It took way too long to get near to the scene and I could see other police vehicles up ahead. It was infuriatingly frustrating.

Eventually, after crawling along for a stupid length of time, the police car pulled in and mounted the pavement, the officers inside directing me to do the same. We were still sixty metres or so from the scene and I had no idea where exactly the patient was and what state he may be in. I had been asked to report for HEMS but time was slipping away if there was any hope for him, even with an emergency doctor.

I ran all the way to the store with my bag. It weighed more than ever for some reason and the crowds made the jog very hard work indeed. I was wheezing like an asthmatic old man by the time I got to the doors of the place. The cops were with me but none of us knew where to go and nobody was there to guide us. Clearly the needs of shoppers came before the care of a stabbing victim.

The police got on their radios and the location – at the back of the store – was given. By the time I reached it an ambulance was on scene and the patient was inside being treated. I should have taken the back route to the store but I wasn’t given that instruction. I could have saved five minutes had I thought it through. There was a motorcycle paramedic on scene too and he told me what had happened.

A young black guy got stabbed in the back by someone in the crowd while he was shopping. Nobody seemed to know the reason (is there ever one?) but he wasn’t critical and he would survive. It wasn’t a chest wound so HEMS wouldn’t be necessary.

I struggled back into the crowds and got to my car. I filled in my paperwork and moved off in an attempt to get the hell out of there. A sea of bright yellow Selfridge’s bags swamped the area. Obviously it was the sale to be at today. You can tell where the Selfridge building is now because they have erected scaffolding all around the front so that falling masonry doesn’t kill you. I think these people would have thronged the pavement below the hazard anyway to be honest, regardless of the safety measures taken by the store’s owners; such is the level of greed and desperation for a bargain.

I can honestly say that if you were there and you suffered a heart attack, our chances of reaching you in time would have been severely hampered. The irony is that saving a few quid on a toaster may have cost you your life today. Thank God sales are moving across to the internet and that this High Street lunacy will soon slow down...or stop altogether.

Although I tried, I didn’t get clear of Oxford Street and my next call was to a 45 year-old, ‘bleeding PV’ in another department store. Again I took forever to find my patient because no member of staff came to meet or guide me. I had to ask directions and at one point found myself standing in a bloody queue because shoppers wouldn’t let me push forward!

I had to get on to the third floor and opted for the lift rather than defying death on the escalators. I ordered everyone out of it when it reached the ground floor (no more Mr. Nice guy) and there were three people with me when I got in. One of them had the nerve to push the button for the second floor, slowing me down even more, despite my request that I get to where I needed to go first. One of the women in the lift had a few bags with her.

‘Is this worth it?’ I asked her, ‘I mean, did you get a bargain worth all this hassle?’

‘Oh I'm not buying, I’m only here to exchange something’, she replied with a smile.

My God woman, are you mad?

I found my patient after asking directions twice more. She looked very pale. Her daughter was with her and she explained that her mum had gone to the loo and bled while urinating. I glanced over at where the girl was pointing (the ladies toilets) and I saw a huge queue of women standing there, waiting to get in. I still find it incredible that public places don’t accommodate women properly when it comes to toilets. They should build at least three times as many toilets for females as males in any building where the proportion is likely to be skewed in their favour. Either that or a new design for female toilets needs to be created.

The crew fought their way to me and we took the lady back down to the ambulance. All the way down we had to shove and shepherd people out of the way. There were couples arguing and a few people fighting among themselves in queues. It was a scene that truly reflected today’s society I think.

I left the crew with the patient and greened up away from ‘the street of Hell’. FRED had other ideas though and sent me right back into it for a 19 year-old who had fainted. By the time I got to her she was recovering well and an ambulance soon showed up to cart her off to hospital for further checks.

I decided to distance myself from that place and made my way along to Tottenham Court Road. I got one more call to a store in Oxford Street but it was cancelled when it got down-graded to a green1. I finally got out of there and drove to a quieter part of town.

My last call of the shift was for a 75 year-old man with chest pain and DIB. The crew were just behind me and we went to see him together, on the 11th floor of a tower block. He had abdominal pain mainly with some back pain too. He had no cardiac history and wasn’t taking any medicines but the crew took him in and I went back to my base station and handed the keys and FRU ‘phone over to my incoming colleague.

‘Good luck’, I said.

‘Oh, like that is it?’ he replied.

‘Yep', I said.

Be safe.

On the edge

Five emergencies – all of them taken to hospital by ambulance. No timewasters today!

It all starts with another dark morning and I set off for breakfast in the hope that I remain unharrassed until I have at least eaten something. Usually it takes a handful of special ‘pixie dust’ and magic beans to ensure that someone doesn’t have an ‘emergency’ until the daylight properly arrives. Usually.

I drove up the foggy road out of Waterloo and the south, where there is much more likely to be a 999 call made for a sore throat or a runny nose. I made my usual way through Whitehall and past Trafalgar Square. The Christmas tree looked eerily strange in the blanket of mist around it. Pretty but eerie; like Santa was going to jump out of one of the high branches with a machete in his hand.

I U-turned for The Strand and went into McD’s for breakfast (I know, it’s bad for you and all that but I burn it all off during my shift and I don’t usually eat anything else – much – until mid-afternoon).

And it’s Christmas.

So I went in, got myself something unhealthy and paid the lady (no discounts for us). The place was busy, even at that ungodly hour of the morning, with still-drunk and sobering-up party people. A young girl behind me started to shout at a couple of lads she was with.

‘And as for you two, you can sling it. Just f**k off, both of ya!’ she yelled.

She clearly had no sense of dignity or decorum. She was a nice looking girl but her mouth gave her character away and I’m assuming that every capable guy within a few metres of her gave her as wide a berth as possible, given that she limited her vocabulary to a very few expletives and explosive comments (mainly detailing every man’s lack of...well, everything).

She left with a few more rounded phrases and her pointy fingered anger went out the door. She was tall, attractive and foul mouthed. A real catch. Obviously somebody had said or done something to her. Or she was mad.

I left a few moments after she had disappeared from sight, her two male friends hurrying after her, and almost bumped into her outside. A man I recognised from the street came out too and spoke to her.

‘I apologise. What I said was out of order, so I’m saying I’m sorry, Ok?’

She wasn’t convinced and I didn’t have a clue what he might have said. I got into the car and out of their business. But my breakfast was getting cool and I was starving. Still I had to watch this melodrama unfold because I knew it would. The guy’s apology was crap and insincere and she was mouthing off even more. Not only that but she was doing something that I have witnessed time and time again when a female is drunk and out of control in a situation like this – she was egging the two lads on to ‘do something about it’. Ah, the old inequality of sexuality; that old chestnut.

She was stoking the fire – I sat and watched her doing it. Every move was aggressive, every word designed to inflame the situation even more. Now there were two street people involved – I know them both and they are nutters. The two lads with her were sussing out the sport and posturing for a fight – testosterone was leaking onto the pavement. It nearly put me off my food.

She banged on my window (of course she did – I have a uniform on and blue lights on the car). I wound it down and looked at her drunken eyes.

‘Oi. You gotta sort this out. I work for the NHS too and I work bloody hard. I don’t need this aggro!’

I had no idea what she was on about. Maybe she was a mad nurse. I think she expected me to get in the middle of her little debate and argue in her favour because she was a ‘colleague’. Yeah right.

Predictably, after she left me alone (I didn’t say a word to her) it all kicked off. Her two friends decided they could take the street men and punches were thrown. Insults were traded and kicks flew until everyone was back inside the McD’s, where the fight continued. I couldn’t really be bothered with this but I decided to stick around for possible casualties. I’d only get called back anyway. Meanwhile I eyed my breakfast with a heavy heart.

It settled down after three minutes and the security guy inside had caught hold of one of the instigators. Nobody seemed hurt enough for an ambulance, so I left and ate my hard-earned food on the Square.

Soon after eating I was called to a 41 year-old male with ‘DIB’. She was on the 21st floor of a building I loathe going into. It’s wrapped in so much scaffolding net that it looks like a grotesque giant Christmas present.

The crew showed up behind me so we went in together. I had no choice really – I couldn’t get out of the place until the ambulance reversed away first.

Inside we found a panicky man with the flu (possibly). He had a high temperature and was generally unwell. So was I in fact. I came to work with a viral cough and I looked a bit rough to be honest – great for patient morale I think. At least I covered my mouth whenever I coughed.

An hour or so later I was off to a 65 year-old with breathing problems. Again the crew arrived with me and we all piled into her flat. She had genuine DIB, it was obvious to see and she had been suffering for two days before her husband called us. Her ankles were badly swollen and she had a history of two heart attacks in the past few years. Both MI’s had been silent (pain free) and now she was like this with no chest pain. It was definitely worth an ECG.

Her ECG indicated a few anomalies, including ST elevation, which could mean she was having another heart attack but I wasn't sure. What I was sure about, however, was that her heart wasn’t pumping efficiently anymore (thus the swollen ankles). We got her to hospital quickly.

I got my break after that and a few hours later received a call for a 40 year-old ‘collapsed and coughing’. I radioed in to double check that I was needed. The job was over 2.5 miles away and, according to the descriptor, the patient had a bad cough. Wouldn’t I be better off dealing with a more local emergency? Nope, they said. There were no other vehicles and the man had ‘collapsed’, they reminded me.

On the way I was updated with ‘now ? fitting’ and I thought that was ominous. I had seen heart attacks begin with coughing fits, progressing to what looked like a seizure (when in fact the patient is in a desperate spasm to breathe and stay conscious). I thought this might be one of those unusual calls that actually turn out to be a genuine emergency.

When I got on scene there was nobody in obvious distress. No-one came to get me and there were no windmills at all. I was in the right place and there were lots of people walking around. I did a slow area search in the car, turned around and called my Control for advice. They told me they would check the location again. Meanwhile, the ambulance shows up and the crew park behind me.

‘There’s nobody here’, I tell them after greeting them.

I set off with one of the crew to do an on-foot area search, just in case. I walked up a little hill and my colleague walked down it. I saw nothing and nobody drew my attention to anything. I walked to the middle of the hill and was just about to go back and give up when I saw a man lying flat on his back at the top of the street, right outside a shop and in the way of everyone who was passing by. Unless he had an invisibility cloak on and nobody could see him, not a single person cared to let me know he was there.

I went to him and tried to get a response. Nothing. He was breathing but it was very noisy and he had vomited – it was now on my trousers, so I couldn’t mistake it. I looked up for my colleague but he was out of sight and I had no way of communicating with him, so I set about getting the basics. I opened his airway, cleared his mouth of gunk, checked his breathing again and felt for a pulse. All good. But he still didn’t respond.

He smelled of alcohol (I thought) and he was less floppy than a truly unconscious person would be and that made me try something when my colleague finally arrived – I had caught sight of him after a minute or so and waved at him to come and help me. He grabbed his paramedic bag and legged it up the hill; his crew mate wasn’t far behind.

I decided to insert an OP airway and see what happened. The general rule here is that if the patient doesn’t gag and tolerates it, he needs it. I put it in after giving the man a loud verbal warning that it was coming. He didn’t tolerate it at all. He gagged, retched and spat it out on the pavement. Then he unleashed a sudden torrent of violence and verbal abuse, some of which I can’t repeat here – even with letters asterisked out!

He grabbed my chest, pinching some of the skin quite hard and he held on, swearing at me and threatening me.

‘If you do that again I’ll hit you’, he spat.

I had no choice. I sat on him, pinning his body to the ground before he got any weight behind his threat. He was strong and he wasn’t kidding. I managed to get him to let go of my skin and held his arms down by the wrists. His legs were still free, so he used them to kick me around the legs and back until my colleague fell on them for me.

All of this was totally unexpected. He was a middle-aged Asian man. He wasn’t the ‘usual’ type for this kind of violence. Surely there was something else going on here?

We managed to get a BM and found that it was quite high. His hyperglycaemia may have been the reason for his outrageous behaviour. It didn’t make him less of a threat but at least we could rule out (possibly) alcohol or drugs. The smell I had noticed may well have been Ketone, not alcohol.

Ironically, while all this was going on in the middle of a busy street, people became nosily interested. They hadn’t bothered when he was unconscious on his back, possibly in cardiac arrest but now there was entertainment, they came over to stop and watch.

The police were called and they arrived in time to help us keep him on the ground – he was still kicking and thrashing but every now and again he slumped into the almost unconscious state that I found him in. Our vehicles were out of reach and needed to be moved so I left my colleague with them and went to bring my car up to the other end of the street. The ambulance was going to follow me there but we discovered another problem. The ambulance wouldn’t start. I called Control and requested another vehicle and let them know how feisty our patient was.

By the time I had driven back around and brought my colleague's crew mate with me, there was another crew, a Station Officer and a Team Leader on scene. The patient was still being ‘managed’ by the police but he was quieter. He was loaded into the ambulance during one of his lulls and an ECG revealed other possible problems, so he was taken to hospital quickly.

I learned later that he was being monitored but was still hurling abuse at the medical staff at the hospital.

At almost going home time I went to treat a man who had a ‘racing heart and feels paranoid’. I got to the smart apartment and was led in by his emotional wife. He was behaving erratically and looked nervous and agitated to me. Apparently he had suddenly declined to this state over a period of 24 hours because of a high level deal that he was in the middle of with his job at a bank. He said it was worth a hundred million pounds. This is why he was behaving like this. To me it looked like he was having a nervous breakdown. He was at the very edge of sanity and he was ready to fall.

‘How much would it cost to have someone killed?’ he enquired when the crew arrived and we tried to get him into the ambulance. He had pulled on two odd socks during a diatribe in his bedroom which we were all privy too.

The question brought a stunned silence from us and a wail of despair from his obviously suffering wife and we walked him to the vehicle and tucked him in for the trip. He wanted me to come with him.

‘You can come. I trust you’, he said.

As warm and tingly as that compliment felt, I respectfully declined and assured him that the crew were my friends and could also be trusted. He had a new and unsettling glint in his eyes now. He was borderline schizophrenic I think.

As the evening wore on and the fog returned with a vengeance, I was called to a 24 year-old male having an epileptic fit at his workplace in Oxford Street. I arrived to find him in a post ictal state, confused and very sweaty. He had obviously been seizing violently but he seemed to be recovering. He went to hospital nevertheless.

And just to spoil my chances of getting home on time, I copped a job that took me into overtime, whether I wanted it or not. A 40 year-old lady was having a heart attack at a large shop in the West End. All hands to the bridge then.

But of course she wasn’t having a heart attack. She had lost her bag.

The Cycle Response Unit arrived with me and we dashed to her aid, defib at hand, only to find her sitting in the stairwell, surrounded by staff, crying her eyes out. She was a French lady and my poor attempts at getting information caused confusion. I got her name and she got mine. The rest I left with a translator.

I felt sorry for her, she had lost her money, passport...the lot but she wasn’t medically ill. She didn’t have any injury and we weren’t the police. I still don’t know why the staff thought she was having a heart attack. In some cultures there is a lot of wailing and pointing to the chest whenever a crisis, however small it may be to you and I, occurs. In their defence, I guess they were pro-active and if she had been having a heart attack, she may have survived it because we were on scene within five minutes of the call.

I left her to my cycling buddy after I had exhausted all my humanity.

I’ve got Christmas day off, for the first time in four years and I am looking forward to it! Merry Christmas to you ALL and thanks for reading the blog. I’ll be back in a few days.

Be safe.

Hiatus

I have new posts lined up but I'm off for a break now. I'll be skiing in Austria for a few days but will be back with you at the end of the week. Glad to hear you are starting to get copies of the book. Feedback welcome.

Xf

Too thick for Uni

Nine calls – one treated on scene, two assist-only and six taken by ambulance.

Early evening; not really the time of day you expect to be called to a stabbing – especially not at a reputable university.

My first call directed me to a stand-by point around the corner from the location of the incident. A 20 year-old had apparently been attacked and stabbed somewhere in the student complex and I was waiting for police to arrive. We aren’t allowed to go bowling in without police backup on calls where weapons are known to have been used. The assailant could still be hanging around and the scene could still be dangerous. But I was itching to get on with it. The thought of someone potentially dying as you sit metres away like a frightened rabbit eats at you. The people at the other end of the radio do their best but they can be very slow at informing us of a police presence. I’ve waited for a long time at some of these incidents, only to find out, on my own, that the police have been on scene for a while.

An ambulance arrived and pulled up behind me as I waited. It was still light and there were plenty of people around, so I wasn’t particularly concerned about any imminent threat to us. We waited until the first police car arrived, followed swiftly by another. Now we could go in.

One of the ambulance crew walked into the narrow street where the incident was supposed to have taken place and I followed in the car. The ambulance brought up the rear. I saw a windmill further down the road, at the very end and I moved ahead and got on scene within a few seconds, the others were following behind.

A small group of people were gathered around a young girl – a Uni student. She was conscious and I couldn’t yet see what injury she had, if any. I approached and asked what had happened. I could now see that one of the men with her had placed a dressing pad over her cheek. I peeled it back carefully and saw a small but deep puncture wound just below her eye, it trickled a little blood and was beginning to swell badly.

‘She was stabbed with a knife we think’, said the man in charge. He worked for the University – he may have been a lecturer but I wasn’t sure.

Then the girl told me what had taken place. My colleagues were arriving around me now.

‘I was walking through a common room and there were guys around. One of them punched me in the face as he walked past and when I felt my cheek, it was bleeding. He had a knife in his hand. I saw it when he ran off.’

She wasn’t seriously injured, well, not in a life-threatening way and for that she could be thankful but if her story was true it meant that she was the victim of a completely random attack in a place where people are supposed to be grown up. They are supposed to be highly intelligent, educated individuals.

I remember in my naive youth, believing that University students were the best of the best but that just isn’t true. Nowadays, with entry to Uni being less restrictive than ever before and, to be honest, some subjects created merely as a reason to fill classes and gain funding, bad people with bad brains are now being accepted. They come straight from College or High School and they bring their stupid cultures of violence and aggression with them. When I was at Uni there were elements inside the place causing all kinds of trouble – it ruined the atmosphere for most of the hard-working, serious-minded people who just wanted to learn and get on in life.

The poor girl will be scarred for the rest of her life now. The blade had just missed a cranial nerve. If that had been severed, she may have had a facial palsy too. She can pick up her degree in a few years time with a permanent reminder of the ‘best years of her life’ carved into her face.

I went to Chinatown after that call. An 80 year-old woman with an unknown problem and the caller had hung up before completing the details. Calls like that are always a bit suspicious – or there’s a good reason for the interruption. I got there as fast as I could and there was an ambulance crew on scene ahead of me. My colleagues were out of the vehicle and scanning the buildings for the correct address, which was proving elusive. It was a narrow little street (a lot of the streets around Soho and Chinatown are cramped) so our vehicles, which were parked in the middle of the road, were now causing a tailback.

Eventually the right address was found and we moved our vehicles further down the street, although we were still in the middle of the road and had no choice but to stay there. We went into the building and climbed a set of stairs to the first floor flat. Inside a young Chinese man directed us to his Grandmother, who was sitting on the loo, fully clothed, with a bucket of vomit in front of her. She was pale and sweaty but conscious and alert.

The call confusion had occurred because the young man had a speech problem. He understood English but couldn’t communicate verbally; he had to write things down. His Grandmother spoke no English at all. Now I have to learn Chinese.

His Grandmother was obviously ill but we couldn’t confirm anything about her properly, even with written notes, so we moved her to the ambulance and carried out an ECG and other checks. She appeared to have several anomalies on her ECG, including ST elevation, which may indicate a heart attack, so we got her to hospital on blue lights. She remained stable throughout the journey and I hope she got the care she needed, given the problems that existed with basic communication.

A very nice diabetic man next. The 70 year-old had become hypoglycaemic and his worried relatives had called an ambulance, describing his condition as a ‘diabetic coma’. Obviously I ran to this one thinking I was going to treat an unconscious patient. I arrived to find him sitting up in bed wondering what all the fuss was about.

‘Honestly, I feel fine. Why did they call you? He asked.

‘They said you were acting strangely and that you had diabetic problems. Your blood sugar may be low. Can I check it?

‘Of course but I’m absolutely fine.’

He didn’t look fine. He was diaphoretic, pale and couldn’t string a sentence together without pausing for thought. Sometimes he paused for thought so long I believed he was drifting off to sleep. That, I didn’t want.

I checked his BM and it was low; 2.1 in fact. So my next mission was to raise it to a more normal level. I would settle for 5 or 6 before I left the house and I asked his wife to get a sweet drink for him. She brought in some pineapple juice and I asked him to drink it. At first he wasn’t keen but he complied and drank the lot. Then I asked for another glass of the stuff. He finished that one too.

He was still slow and lethargic but I persevered; this process can take up to 30 minutes to complete. The juice brought his BM up to 4 and I asked his wife to bring a sandwich and biscuits if she had them. Now he needed to fill up on ‘slow-burning’ sugar so that his body could fully recover and sustain itself. He ate the sandwich and munched the biscuits and all the while I’m sitting there starving. I hadn’t eaten and was due a snack, I thought. I’d have to wait ‘til this job was done.

It took 15 minutes for him to improve enough to convince me that he didn’t need to go to hospital. I had cancelled the ambulance on the basis of this call being a simple hypo and his refusal to have one appear and now he was making more sense. I got my paperwork from the car and when I returned, he was sitting in the kitchen with his wife and sister, eating another sandwich. He looked a hell of a lot better. He thanked me for my help and generally praised the ambulance service, and then I was off, happy to have done a simple, life-saving job.

I didn’t get a chance to eat; I was called to another diabetic emergency as soon as I greened up. This time an 80 year-old man was described as having a ‘diabetic fit’ in a public place. I got there and was directed to a reception area by staff. I waited and got ignored.

‘Excuse me’, I asked the receptionist (who was busily chatting to someone), ‘Is there someone in need of an ambulance here?’

‘Yeah’, she quipped, ‘they’re bringing him down in the lift’.

‘Why are they moving him?’

‘I dunno – they’re bringing him down. That’s all I know.’

There must be a special training school, perhaps even a charm school for people like that. I wasn't charmed, however and I let her know.

'They shouldn't be moving the patient, they should have taken me straight to him.'

Her face said 'like I care', so I decided to act.

I went to the lift area and two members of staff came towards me with a man in a wheelchair. He had a friend with him and it was noticeable that none of them were fitting or had been fitting in the recent past. I was told that the man had ‘gone a bit funny’ and, realising his blood sugar had dropped, his friend had quickly sorted him out with glucose sweets which were conveniently kept in his pocket for just such an emergency. This is exactly the sort of self-help that diabetics rely on. They do NOT want to see ambulances showing up for them every time their BM dips a bit. Over-reactive and panicky staff at public places (with more of an eye on liability than responsibility in my book) will dial 999 at the drop of a hat and then use descriptions that simply don’t bear relevance to the situation in order to secure a rapid response. What sounds better to you?

‘I have a diabetic who is a bit confused’ or ‘I have a diabetic who is having a seizure’

I know it’s cynical but the man being wheeled to me was instantly aggressive towards me and his friend, who happened to be a GP and whose nose was definitely put out of joint by my presence, was not happy about the drama that had been unfolded on their behalf. In short, they were acutely embarrassed and I was the target of their humiliation. I can understand it too; if I was treated like an emergency when I was quite capable of treating myself, I would be mortified at this over-the-top response.

Then, as I was calming them both down, the ambulance crew arrived. Oh dear, what have we done?

I checked his BM (I had to really) and he allowed that much. I found it to be normal (quel surprise!) and both men left the building – the ‘patient’ still had to be wheeled out at the insistence of the staff. Why, I don’t know. He wasn't happy at all.

I worked with the same crew on the next call – a 30 year-old female, ‘unconscious on a bus’. Now, this was different. Most of my 'drunk on a bus' patients are male. I got to Lower Regent Street, where the bus had stopped and the driver met me at the door.

‘He’s upstairs. I tried to wake him but he is completely unconscious’, he said.

Ahh...so she is a he after all, I thought.

‘Is he drunk?’ I asked, ever hopeful.

‘I don’t think so’.

I went upstairs and there he was, slumped at the very back of the bus, along the seat. He was young and looked out of it, even from a distance. I didn’t think he was drunk either. He wasn’t sleeping; he was unconscious. His breathing was very slow and very shallow. He wasn’t suffering the effects of alcohol.

I tried to rouse him but got nothing but dead weight and heavy limbs. I adjusted his airway and took at look at his eyes. Pinpoint pupils. I worked on the presumption that he had taken a drug, possibly an opiate – probably heroin.

The ambulance hadn’t arrived yet, so I gained IV access and gave him Narcan. The lights were off on the bus and the driver had left me to it. I was up on the deck on my own, in the dark, with a drugged up man who may or may not come out of his stupor soon. I knew that he wouldn’t be the most passive person on Earth when he came round.

He didn’t come round, however and the crew arrived to help me sort him out. I gave him more Narcan and all his obs were completed while we waited. His arms had puncture marks on them, so it was still a highly likely drug-related problem we were dealing with. I hoped I was on the right track. But he didn’t respond to the second injection. He should have improved by now.

The police arrived and watched as we went through a number of other checks and I administered even more Narcan. An OP airway had been inserted and he had tolerated it but only for a few seconds. He spat it out and began to rouse a little. Then he sparked up and began to get aggressive with my colleague who just happened to be near him. He thrashed around and swore at him, threatened him and tried to punch him. The cops moved in immediately and sat on him until he calmed down. Then he slid back into his coma.

I gave him more Narcan and he climbed back up to a point where he was manageable but not awake enough to do any harm. We lifted him down the stairs to the waiting ambulance. I had been on the top deck with him for almost 40 minutes. He remained quiet for the trip to hospital. I gave him no more Narcan; I didn’t need him fully alert.

Back to normal with a 40 year-old female ‘drunk and unconscious’. She was flat on the floor of an exclusive Soho club when I got on scene but she responded to pain, so she wasn’t too bad. She’d still need to go to hospital because she was unfit to travel anywhere else and her friend was cringing with embarrassment. Why do people do that to their friends?

Then there’s GHB – the drug of choice for the (mostly) young gay community. The call took me outside a gay club in the West End. I’ve been here several times recently and I don’t like the place at all – it heaves with drunken, badly behaved individuals who have nothing else on their mind but ‘having a good time’ at the expense of others and the complete and utter disinterest of all else around them, except their own group. They often obstruct our vehicles as we try to get in and will not move from the dance floor, even when we are carrying a patient out.

I didn't know but there was an ambulance crew waiting at a stand-by point down the road. They had been told that the patient was violent and to wait for the police. I had been told nothing. I cruised into the dead-end street, full of people, without a thought. The crew saw me go in and the police, who had arrived in force went right past the street, bless 'em. The crew decided to come and help because they knew that I didn't know what they knew...if you know what I mean.

The police did a U-turn, found the right street and joined in the fun. But there was no need for them.

This young lad was lying in the gutter having ‘fits’, according to witnesses as a result of his recent GHB adventures. He was loud, annoying and at times aggressive to me and the crew, especially the crew. In the vehicle he was cannulated by the ambulance paramedic but he ripped that out as soon as it was in. Then I had a go and he ripped that one out too. He needed fluids but he wasn’t letting us help him. His female friend sat teary-eyed on the chair, watching him make a fool of himself.

I was annoyed with him. He was a spoilt brat as far as I was concerned. Professionally, he was getting all the help he needed and he was being handled properly but personally, I couldn’t care less if he wanted to waste his life using this stuff. The people who pay are the people around him and tonight, right now, it was me, the crew and his crying friends. He will survive his episode because the ambulance service is on hand to scrape him up and take him to a safe place.

At 5am the bread delivery man called for an ambulance when he stumbled across a man with a head injury lying unconscious in the street. I got on scene and he (the bread man) flagged me down. He pointed into an alley and I saw a large man lying in a pool of blood.

‘Did you try to wake him?’ I asked.

‘You must be joking mate, I never went near him!’

I looked at the bread man – he was a good three inches taller than me and a bit wider. I looked at the slumped man. I went over to him and shook him hard. He moved. I shook him again, noting the blood which had formed a pool around his head – he had a nasty gash in his forehead. He had fallen and sustained that injury, or he had been hit. I didn’t know which and when he came round and sat up, he didn’t know either. In fact, he’d rather not go to hospital because he was ‘okay now’. I disagreed and the crew arrived to help him make up his mind. He was taken to hospital.

Another ‘drunk on a bus’ and this time it was a more familiar theme. He was drunk, East European and aggressive. He had crutches with him but denied they were his. He had wet himself and his trousers were loose, always a happy combination. With the help of the crew I managed to get him off the bus but he wasn’t pleased and seemed to be miles away from home.

As the bus drove off I turned around in time to see the man run after it, crutches in hand, and leap back on without the driver knowing what had happened. Oh well, some other poor slob will get that job later on. I’m off home.

Be safe.

Glass and sand

Eleven calls – two conveyed, one false alarm, one cancelled on scene, one refused and all the rest went by ambulance.

Early warning signs of migraine include visual disturbances and ‘paralysis’ or numbness of one limb or side of the body. After a short while, the headache begins and the other symptoms fade.

My first call, before I had even completed my VDI, was to a 25 year-old man who had distorted vision (he thought he was going blind) and ‘paralysis’ of his right side, although he could walk perfectly well. He had collapsed outside a posh hotel and the staff (whether through kindness or the need to quickly remove such a distraction from their threshold) had called an ambulance immediately.

When I arrived I wasn’t sure what I was dealing with and the possibility of a stroke, however unlikely in his age group, was hovering around. But his vitals were normal and he had no significant medical history...not even migraine. The ambulance was going to be a while, so I took him in the car – the hospital was literally across the bridge and it took me five minutes to get him there.

Only when I got to A&E and the nurse listened to what I had to say did the possibility of migraine enter the equation properly. The nurse had personal experience of such fore-warnings and confirmed that this was a likely diagnosis. The man had said this had happened to him when he was younger but was never diagnosed because by the time he got to hospital, it was better.

‘How is the numbness and visual problem now?’ asked the nurse.

‘It’s much better’, replied the patient, now sitting on a chair inside the Majors department.

‘Do you have a headache?’

‘Yes, it’s just started’, replied the man. I think he was surprised at the nurse’s predictive skills.

That clinched it of course. The migraine was kicking in and all the other symptoms would go away. I left him sitting in the triage area, awaiting a proper examination.

South of the river now for a 65 year-old man who had ‘cut his hand with a saw’. I got to the address, went in and found him sitting on his sofa with a deep cut to his thumb. He had done exactly what it said on the tin, so to speak. He had sliced through the bottom of his thumb with a rusty old saw while he was cutting wood for the new floor. His daughter was with him and she had placed a cloth over the wound to stem the bleeding.

I replaced the cloth with a sterile dressing and took them both to hospital; he’ll need stitches and a tetanus injection.

My next call, for a RTC involving a motorbike and a pedestrian, turned out to be a false alarm. A woman living in a flat on a busy road had heard a screech and a thud, looked out her window and seen a motorcyclist with a pedestrian who looked as if s/he was hurt. She dialled 999 but neglected to return the call and tell us that she had been mistaken. Nothing had happened and there was nobody on scene when I arrived. The ambulance appeared as I cruised around looking for a likely patient. In her defence, she bothered to come out to see me and apologise for wasting our time. Fair enough. It didn’t do her any harm that she was very pretty too :-)

Then a 24 year-old ‘passed out, been drinking’. Sure enough, she was drunk and barely able to open her eyes, even to painful stimulus. She had been vomiting heavily and her friends were doing their best to avoid standing in the pools she had left around herself. They were obviously embarrassed. One of them even asked me if calling us was the right thing to do – he seemed genuinely worried (maybe he reads this blog). I found myself reassuring him and telling him it was the right thing to do. She was in such a state that a taxi home was out of the question. I know the difference between a drunk who can get home and one that needs IV fluids and a long rest in hospital. She was the latter.

I was on stand-by in Soho and Control sent me south for a DIB at a police station (in custody). These calls are almost always fantasy acts by prisoners who want out of their cell and into a nice clean hospital bed. They invent fits, unconsciousness, self-harm claims and the all-time favourites DIB and chest pain to get them out of those stinking little rooms. If they want a nice warm bed they should stick to legal stuff.

Off I went and it took me over ORCON (I was late). I arrived to find an ambulance already on scene. Great. I went in and met the crew. They had come from 4 miles away and they were chatting to the ‘DIB’ at length about why he needed an ambulance. There was nothing short about this man’s breath. I decided I wasn’t needed and to add insult to injury another crew turned up for the same job. I spoke to the crew and explained what was going on. Then I watched as the first crew on scene, who had been trying to get back to their own area so that they could return a medical team and equipment, left the police station...empty chaired. No patient. Waste of everyone’s time.

Up north now for a 50 year-old male, ‘fallen over. Cut to head. Choking’. I was confused by the mixed description here. He was choking? I raced to the scene and pulled up outside a pub in a less than desirable part of town. I looked over to a small group of people who were waving frantically at me. One of them ran towards me. On the ground I could see a very large man being pinned down by three or four other men, one of which had a finger in the prostrate man’s mouth. Maybe he was choking, I thought.

I got out, ran over before I was accosted by the man coming to get me and knelt down next to the big man on the ground. His friend’s finger was stuck inside the man’s mouth because he was biting down on it. He wasn’t choking after all, I presumed. Was he fitting?

I asked them.

‘Is he epileptic?’

‘No, he aint got nuffink wrong wiv im’, one of the replying voices said. I’ve no idea what the others said - I could just barely decipher that one.

I looked at him and tried opening his mouth so that his friend, who was now screaming in pain, could get his finger back but the man’s huge jaw was keen to hold on. I was keener to have this problem resolved, so I persisted and angrily told the man to let go. It took another ten or twenty seconds but his jaw relaxed and his mouth opened. A bloody, half-chewed finger leapt out, thankfully still attached to the screaming friend. I had to assume they were friends for them to be that close.

Now the big man started throwing his weight around on the ground. His fist made contact with my body several times and I had to lie across him to keep him still. I asked two of his mates to pin down his arms while I worked out what the hell was going on. Then I got a punch to the head and that was it. I called control while the others held him to the ground.

‘Is there an ambulance coming?’

‘Not yet. Nothing available.’

‘Well can I have some police help here please. I’m on my own with a very strong guy who is thrashing on the ground. I keep getting thumped. I need some help to control him and his mates.’

The scene was getting disturbingly menacing. Two of the men had decided to fight with each other. The big man’s wife had lit up a fag and was nonchalantly puffing on it, six inches from my face as I struggled to cope with his wrestling antics. The others had wandered off to discuss something I couldn’t hear and his son was welling up in a corner. I thought I was part of a circus routine for a minute.

The man relaxed and I let my guard down. I really, really, didn’t believe him. His family told me he had been in a fight and had fallen down unconscious, then he had started thrashing about uncontrollably and yet I detected a lot of conscious effort in him. There is an easily recognisable difference between a true seizure and one that is being played out.

Before long he was off again. Violent flailing and rolling, pulling me with him. He was on oxygen now but the mask ripped off his face. My service mobile was punched out of my hand and I got a swift kick to the ribs from God knows where. This went on for another minute, then he settled again.

Sirens were wailing in the distance. It seemed like a LOT of sirens. I told the family that the police were coming but not to worry because they were coming to help me out. What I didn’t expect was an army, however. I think someone in Control thought I was being murdered; three police vans showed up. Another FRU paramedic pulled up just ahead of them (and he was all I needed to assist me to be honest) and then the crew arrived in the ambulance.

When he heard the sirens get close, the big man began thrashing about again. Two police officers held him down until he regained his composure. All the time I was trying to convince him to stop doing what he was doing. Then my colleague from the ambulance spoke to him after my hand over. She and her crew mate lifted him to his feet and walked him to the vehicle. He was as gentle as a lamb!

He had been faking all of it and now that he had a huge audience, he was too tired to carry on. He apologised to me and I was left with bruises and a limp for my trouble.

After a cleanup and a bit of a rest I headed out to Leicester Square for a 25 year-old who had been assaulted and was ‘?suspended’. I doubted it but I got there at an appropriate speed.

He was lying on the ground in a pool of blood. He had a head injury and his eye had been mashed, probably by a bottle. He wasn’t fully conscious and kept asking for a drink. The police were on scene and an ambulance had pulled up just after I got there, so he was taken away quickly. I don’t think he had life-threatening injuries and I had checked him thoroughly for weapon wounds. He had got himself beaten up and he probably wasn’t innocent – they rarely are in these situations.

I was finishing my paperwork and a lot of police vehicle flew past me, one after the other. They were stopping just up the road at the tube station, so I asked Control if there was anything going on I could help with.

‘We have a call coming in that a man has been stabbed. Can you deal?’ they asked.

I greened up and drove all of a hundred yards to get on scene. The whole of Charing Cross Road had been closed off by the sea of police vehicles that had parked there. Armed and unarmed cops roamed around. Buses were now queuing up and down the length of the road; instant congestion at 3am.

I made my way to the police officer I thought would know what was going on and found myself looking at the stabbing victim. He was standing talking to the cop in the middle of the road. He had been stabbed in the hand by a random person who he claimed was now grinning at him from the window of a cafeteria across the road. He couldn’t prove it but he was pretty sure it was him.

I examined his wound. It was no deeper than a scratch and a splinter would have trouble getting into it. I couldn’t believe the manpower that had turned out for this. Maybe my experience with the number of police that had appeared earlier for my little altercation was simply indicative of how edgy the cops were tonight.

In the end I cancelled the ambulance before we embarrassed ourselves further and the guy refused to go to hospital. In fact, after a long debate with the police, he decided he didn’t want to go any further with it and simply walked away. It took twenty minutes for the roads to get back to normal.

My next call was also an assault. The 25 year-old had been ‘glassed’ by a guy he had taken exception to and decided to challenge. He had a small, insignificant cut to his forehead. He was also drunk.

Finally, just as I was creeping back to my base station in the hope of an early night, a call to a 25 year-old female in a night club. She had fallen down a flight of steps and cracked her head open. She was conscious when I arrived (the ambulance crew were just behind me) but not very stable. There was blood coming from inside her ear and that isn’t a healthy sign.

The steps she had gone down were made of glass. They were also covered in sand for some bizarre reason. She was, of course, wearing heels and not-very-sensible shoes because she was on a night out. So the combination of alcohol, unsteady gait, high shoes, glass and sand made this kind of accident inevitable. I told the club Manager what I thought of his steps and amazingly, he agreed that they were unsafe. Incredible that he hadn't thought of it earlier.

We carefully (because all of us were slipping on these steps) lifted her up to the ground floor and onto the trolley bed. She had a head injury and this was causing her to behave erratically, so it was a bit of a struggle trying to get her to comply with our wishes. Luckily her drunk but sane friend kept things running smoothly by talking her down whenever she decided to try and fly.

I left the crew to get on with it and made my way back to civilian clothing.

Be safe.

Trouble with the book

I've had a few emails and comments about individuals having difficulty getting hold of the book. This shouldn't be happening to you and I am at loss to understand it. If you are having problems, click on the link to my publisher and order it directly from them. Otherwise, Waterstones, Play.com and Amazon, among many others are currently stocking it around the country.

Please give me feedback as soon as you receive your copy so that I can gauge how well (or not) deliveries are going. Remember, of course, that it is two months late (mostly due to me re-writing it from scratch) and that now the Christmas season is here, distribution and delivery may be slower than usual.

I will be placing a new link, with a picture of the book cover on this site soon so that you can buy direct from the publisher if you want one (or twenty).

Xf

Bad behaviour

Eleven emergencies – two assisted-only, one no trace and everyone else got an ambulance.

The ‘booze bus’ is back on the road, ready for the Christmas and New Year onslaught. The Patient Transport Vehicle comes out and picks up as many drunks as possible, carting them all off to hospital under an agreement put in place a few years ago. This frees us up on the frontline to deal with genuine emergency calls. Personally, I think the guys who volunteer to do the job are heroes. At this time of year it would be more of a nightmare than ever to work; the booze bus crew, often made up of a non-frontline team with blue light driving skills and a frontline EMT or Paramedic, can ‘clean up’ the streets for us. All we have to do is call for them and if they aren’t currently working elsewhere, they will appear, as if by magic and remove the offending item.

If you see the booze bus around, give the crew a wave. Thank them whenever you can. Later on, they might be standing in a pool of your vomit, rescuing you from the gutter.

The Evening Standard recently reported that alcohol related incidents were up 70% in almost every major city in the UK – only in the City of London has the figure risen comparatively moderately – by 25% - but then most places in the City are shut after working hours, so there’s little scope for drunken idiocy among the sleek, shiny towers of commerce.

If our workload has increased in line with this statistic, we are in a lot of trouble.

My first call of the shift was to a 35 year-old man whose motorcycle was hit by a car just outside the LAS headquarters in Waterloo. I was literally seconds from the call but didn’t hear anything going on just up the road. When I arrived, traffic was slowing down and a queue had formed along the road. Staff from HQ had spilled out to help the poor bloke who had been hit. His body had travelled some way through the air and he had landed with a clearly fractured ankle in the middle of the road.

I was the only uniformed person on scene and I wasn’t sure who else I was working with, they all had suits on.

‘Can I establish skill levels here please?’ I asked before I allowed anyone else to mess around with the man on the ground.

‘Paramedic’, said one of the suited guys. ‘Paramedic’, nodded the other.

Well, I had to be sure but I don’t think they were too pleased about the challenge.

By the time I had completed my initial checks and the man’s ankle was being examined (he was obviously hobbled) there were more uniformed members of staff on scene. Too many probably.

The crew arrived and I handed the patient over. I had given him morphine for his pain and he was sucking on entonox to supplement it. He was taken away quickly and the road was cleared and opened for traffic. We had caused a bit of chaos for a time.

I couldn’t find the address for my next call to a 75 year-old man with chest pain. The crew drove up and looked confused too. Then they headed further down the road and located the place where I was supposed to be – it’s a lot easier when you have another pair of eyes looking out for you. I left them to it and greened up.

I got called to a 45 year-old female having an epileptic fit at an underground station within two minutes of declaring myself available and off I went. Again, a crew had arrived and I wasn’t required but as I completed my paperwork another ambulance arrived. They had been given the same location and call description but a different age for the patient. Two calls had been made and the difference in age generated two CAD references, thus two ambulances. I clarified the confusion and they left the scene. The woman hadn’t been fitting anyway; I had popped down to check.

Green Park tube station next and a 25 year-old male, ‘lying in street’. When I got there I couldn’t see anyone lying anywhere. The crew arrived two minutes after me and they couldn’t find him either. He had probably woken up and wandered off. A small group of people giggled and pointed at the silly paramedics with their blue flashing lights and noisy sirens...and nobody to help.

A panicky 81 year old man with chest pain and dizziness at a housing estate later on. He had taken his own GTN for his angina. This had brought relief and he seemed to be settling down again. He had a problem with vertigo and this had triggered his panic and chest pain. I left him with the crew – he would still go to hospital just in case his pain decided to return without warning.

Another RTC. This time a man on a bicycle managed to get himself knocked down by a car. He had been creeping over a very busy junction, against the red traffic light and a car had clipped his front wheel, lifting him up onto the bonnet and carrying him 20 or 30 feet before depositing him with a thud on the ground. He had a badly broken nose, burst lips, which were bleeding badly and broken teeth.

Bystanders had tried to make the scene safe by slowing traffic down but it was still very dangerous for him when I arrived. The car that hit him was way too close to his head and moving vehicles were coming through the lights and swerving to avoid his feet. I got another cyclist to direct the traffic (he had a hi-vis vest on) and had the offending car moved away.

The man was conscious and alert but his face was a mess (it had hit the car’s windscreen with the full force of the impact) and, although he asked me to find his missing teeth, they were never going to be put back. At least six of his best teeth had been smashed and were ragged, shark-like protuberances which would need a lot of dental work.

The crew arrived and helped me collar and board the poor bloke. The police were nowhere to be seen, despite several calls to Control to get them there. A couple of patrol cars even went by but didn’t stop. I couldn’t believe it. When a siren-wailing, light-flashing police vehicle did show up and stop to help, I discovered they were on a different job but decided to make this a running call. I wondered how long we would have waited for them.

The driver of the car that had hit the cyclist was standing on the pavement in a state of shock. I felt sorry for him, it hadn’t been his fault and cyclists continue to make themselves vulnerable to this kind of accident. How many spare a thought for the car driver who will have to live with the injuries or death caused by their actions when they cross a red light and attempt to weave through moving traffic?

I was called to a night club in the city next for a 25 year-old female ‘not alert’. That probably meant drunk. I raced to the scene and found the police already there and an ambulance crew getting out of their vehicle. Another FRU paramedic was already inside talking to the fully alert woman and a second ambulance arrived within a minute or so outside. I wasn’t required and this call was over-resourced, so I asked Control what was going on. Apparently two separate calls were generated for this lady because someone else had dialled 999 and said she was in cardiac arrest! How can that mistake have been made?

A bizarre call to a very large Asian lady next. I had been on scene only a few minutes with her and her family when the crew arrived and joined me in what was rapidly becoming a joke call. She had called an ambulance because she had back pain and couldn’t move – at all. She was lying in a most dramatic way on the little bed in her front room and she made a point of crying out and wailing about her discomfort every time I asked a simple question. She had been suffering back problems for months and her doctors didn’t have a diagnosis. She had been given tablets but that wasn’t enough and now she wanted attention.

She may have been in pain but I wasn’t convinced. Neither were the crew and we planned a way of getting her to go to the ambulance because up until now (20 minutes after I had arrived) all she wanted to do was be rude to us and demand pain relief, whilst at the same time refusing entonox. She adamantly refused to move herself and insisted that we bring a chair in for her and carry her out. She was a large lady and there was no way, without a valid clinical need, that she was going to be carried. It was unnecessary.

She took the entonox but didn’t use it properly – pretending to inhale the gas with little whimpers instead of deep breaths. Then she flung the tube and mouthpiece away like it was a bit of rubbish. I wasn’t happy with that and I asked her not to throw expensive ambulance equipment on the floor. I reminded her that other patients would need to use it. She didn’t care and now she hated me. I didn’t care.

Through long negotiation and almost an hour of stupidity, she was ‘walked’ out by one of her sons. Her arms were high in the air and he literally lifted her feet off the ground and ‘skipped’ her along to the ambulance. It was the most unlikely and demeaning thing I have seen in a while. She wailed at the top of her voice. It was 2am and her neighbours must have heard her. She was embarrassing herself and her family.

She sat down on the ambulance step, refusing to go further. We were all getting fed up of her behaviour now. We managed to get her to crawl the next few feet and then she saw the stretcher – she threw herself onto it, despite being asked to sit on the chair. She simply didn’t care what the crew wanted. I suggested that maybe it would be easier to transfer her out of the ambulance if she was on the bed and the crew agreed. I think they were too tired to fight with her any longer.

Incredibly, as soon as she was away from her family (who had been openly worrying about her), she stopped complaining about her pain and stayed completely quiet all the way to hospital.

Next – a 22 year-old male ‘drunk and vomiting’. I still don’t understand why this description generates an emergency call, regardless of the tiny little statistic that says a couple of people choke on their vomit. Most drunks who vomit are just drunk...and sick. As it happened, I arrived to find a young Italian man on the ground, drunk. He had also vomited. His friends were embarrassed and didn’t know where to look.

‘Why do you think he needs an ambulance?’ I asked them.

‘We don’t. We want a taxi to take him home’.

The crew arrived and together we persuaded them to do just that.

My first elderly ‘drunk on a bus’ next. Usually, they are young and a lot of them are East European (sorry but they are). This one was English and a pensioner. The crew and I helped him off the bus and he wandered around trying to find a route home.

My last job of the night was a 35 year-old man who insisted his name was Mr. fuk-hugh. He had taken an overdose of Ketamine and was in a bit of a state when I arrived. The crew met me a few seconds later and the police joined in the fun. We all stood in the ambulance with the man, who was recovering a little on oxygen, and tried to keep the grins from our faces whenever he repeated his name or was referred to by it. I still think he was having us on but the police were convinced and they had checked out his ID. Or it was a lie and they wanted to keep us amused.

I’m not very good at keeping a straight face when something is cracking me up so I had to turn my back on him several times when he was being asked questions.

‘Sir, what’s your name?’

‘Fuk-hugh’

My colleague had to resort to pretending that he had forgotten it so that he didn’t have to say it. I think he used the name ‘thingummyjig’ instead at one point. This made me cry.

Be safe.

Unhealthy exercise

Six calls – one conveyed, one false alarm and four taken by ambulance.

My near-faint calls are almost always simple affairs. Get there, watch them recover and either take them in for obs or let them get on with their day, depending on various factors. My first call today was to an 18 year-old male who had almost passed out on a train. It looked like the ‘usual’ type of call to me but when I got on scene he explained that he had a congenital heart defect; aortic valve regurgitation (a leaky heart valve).

He looked pale and was very weak, considering how young he was. His pallor and lethargy made his condition very relevant and so I took it seriously, although he showed no sign of imminent collapse. The crew arrived shortly after I started my obs and he was taken to the ambulance for an ECG, which turned out to be abnormal. To be honest, I wasn’t sure if the abnormalities were significant or usual for this type of heart defect but none of us were taking any chances with him, so he went to hospital for a more in-depth examination.

I conveyed my next patient in the car. She was a 50 year-old lady who had collapsed at work. When I got to her, she had been waiting almost an hour for an ambulance. She had a headache and felt weak but was otherwise okay, so I took her myself, rather than wait any longer for transport. At first she was reluctant to walk with me to the car but her need to go to the toilet overtook her fear of falling down and I used the trip across the hall to the loo as an excuse to divert her to the car (after she had been to the toilet, obviously). She recovered well on oxygen and was in good spirits when she arrived at the hospital. I had to borrow a chair from one of the crews because the hospital was full of people and every wheel chair was being used. When I returned the chair to the crew a very strange thing happened.

‘Thanks for letting me use your chair’, I said to my colleague (who I didn’t know at all).

‘No problem...and thank YOU for bringing that patient in’.

That was the first time an ambulance crew had ever acknowledged the small part I played in freeing up vehicles by conveying non-emergency patients. They were obviously very busy in this part of town and grateful for the help. It’s nice to get a pat on the back from a colleague. Rare but nice.

A call to the Polish Embassy in Central London where the queues outside seem to last all day, starting in the early hours. The call was for a 30 year-old male ‘? Fitting’. I arrived and battled my way through the crowd of Polish people at the doorway. Inside the security guy pointed to a tall, thin man who was standing at a table. He had cuts and bruises to his face; he looked like he had just been fighting someone. He didn't look post ictal, so I don’t think he had been fitting. I wasn't sure what he needed an ambulance for and the security man didn't offer any explanation for the state of his face. I smelled a rat.

The ambulance pulled up outside and I walked the man, who didn’t or couldn’t speak English, to the waiting crew. I left them to it and did my paperwork. Then off I went to my next call – a 30 year-old collapsed after jogging.

When I arrived I was directed to an alleyway by a canal. There was no way I could drive the car down it, so I got all my bags out and walked the 100m or so to a small group of joggers who were standing or crouching over a man on the ground.

The daylight was beginning to fade and the grass was damp, so my obs were carried out with wet knees and a pen torch.

The man had been jogging with his work colleagues when he suddenly collapsed and became unconscious. Now he was awake but he didn’t seem aware. At first I thought he may have had a seizure but he was able to shake his head in answer to my questions. He wasn’t epileptic and he had no medical problems. But he wouldn’t talk to me. He kept trying to go to sleep in the grass. His behaviour was quite unusual.

When the crew arrived we took him to the ambulance and continued our checks, including an ECG and that’s when we discovered a potential problem. He had pronounced ST elevation and, considering his recent activity ( I was told he wasn’t a regular jogger and that they had been running hard), there was a real possibility of an MI here.

He was ‘blued’ into the nearest cath lab but their investigations showed no coronary obstruction, even though their own ECG’s confirmed the changes we had seen. In fact they observed an increasing elevation during those tests. It was a mystery.

No doubt he was kept in until they got to the bottom of his problem. There are many things that can cause sudden collapse after strenuous exercise but finding a single cause can sometimes be a question of knowing the right things about a person’s medical history and waiting for the next event to occur.

I had a rest after that job and got called back to the Polish Embassy when I was suitably refreshed (coffee and cake). I knew I was going to the same man.

When I arrived, the crew were pulling up. I explained what had happened earlier in the day and they came with me to check the ‘patient’ out but he was gone. He had run off when he heard the sirens. Now I knew what was going on. He was obviously not wanted by the Embassy staff and they had called us to get rid of him. The police probably wouldn’t come, so they had used the ambulance service, more particularly our lights and sirens, to get him to clear off. It is a disgusting abuse of the service by an official Government institute in my opinion.

This time the man was lurking around the corner with his bruised and battered face (we never found out how that happened). He had gone to hospital with the last crew, walked straight out of A&E and come back to the Embassy. He was a nuisance to everyone, so we made a point of finding him and warning him off (after asking him if he needed an ambulance of course). He hadn’t called us but we made it clear to him that he was not to trigger calls from anyone else. I think he understood but I don’t think he cared. Luckily, I didn’t see him again after that but I wonder if others crews were called to him.

Finally, a call to a 35 year-old alcoholic who had been fitting in a hostel. When I asked him about his seizure he denied anything was wrong and tried to stand up. He was very unsteady on his feet and was diaphoretic, although he seemed to be recovering. The hostel staff had called us and they were concerned about him after witnessing him fitting for five minutes.

The crew arrived within ten minutes of me and he was quickly taken to hospital. Thus ended another day at the office. The nights are fair drawing in, as we say in the Homeland.

Be safe.

Speak of the Devil

Six calls - two assisted-only, two conveyed, one dealt with by police and one taken by ambulance.

The underground is a common place to faint. The hot, crammed inside of a tube train does nothing to enhance circulatory flow and if you are feeling ill, weak or in any other way vulnerable your body might decide to shut you down for a short while until it gets a grip of itself.

My first call for a 25 year-old female ‘feeling faint’ was to an underground station but, as is usually the case, by the time I got to her she was already recovering. An off-duty doctor (another thing you can almost guarantee getting on the underground) stopped to render aid and the woman was being plied with food and water (she hadn’t eaten this morning apparently) to help her get better. It worked because she declined further aid and I cancelled the ambulance. She continued her journey to work. Next time I'm hungry I'm gonna faint on the tube.

I took a 61 year-old female with abdo pain and dizziness to hospital myself because she is a regular caller with nothing wrong with her (well, she has a long history of ulcer but apart from that nothing else). Staff at the hospital know her very well and are less than 100% sympathetic when she shows up but she lost her husband a few years ago and has never been able to accept it – now she calls us out whenever she feels lonely and unable to cope. She uses her ulcer to get an ambulance (the dizziness is added in for extra effect, as is DIB or chest pain, depending on what you've used up before).

A call to a 45 year-old ‘fitting’ at a bus station next and I found myself driving towards a man in a wheelchair. His friend (the man pushing the chair) was windmilling me over and pointed to his non-walking mate, telling me he had been fitting and was still ‘not right’. He looked post ictal and was behaving a little oddly. He kept getting out of his chair as if he was ready to do a runner (which prompted me to wonder why he needed the chair at all) and had to be restrained.

The man was an alcohol from the nearby hostel; alcoholics have withdrawal seizures brought on, ironically, by a lack or complete cessation of alcohol. I had to be careful not to confuse his condition, however, as he may have genuinely been epileptic. His friend confirmed that he wasn’t (that he knew of) and so I asked when he last had a drink.

‘Last night, I think’, said the helpful friend.

Usually it takes longer than 24 hours without a drink to cause fitting, so with the possibility of other causes lingering, the ambulance crew took him off to hospital, just in case.

A 23 year-old female with ‘DIB’ and described as having ‘heart problems’ turned out to be a panicking young French woman with hyperventilation who was recovering by the time I arrived. The MRU medic showed up too but it was unnecessary. She refused aid and felt very embarrassed by the fact that her manager had called us at all. As for her heart condition, she denied having one, although her boss was still insistent. We left her to work it out with him.

I had been talking about some of our regulars with a colleague at the station at the start of my shift and I happened to mention a particular menace that I hadn’t seen for about six months. He calls us out for ‘chest pain’ and then abuses everyone in his path. He is thoroughly convinced of his right to go to hospital every time he calls – which can be two or three times a day. By some fluke of chance or the cruel hand of fate or whatever you want to call it, he turned up on my next job, almost as if I had summoned him!

He was on a bus in the City. He was very drunk and very rude. The police were on board chatting to him but they were also around the corner at another call, dealing with an elderly lady who had fallen and sustained facial injuries. She had been described by the police as a 'woman with a smashed up face', which kind of simplified my version of her injuries. She had fallen very hard. Unfortunately, I wasn’t there for her, I stumbled on that call by accident as I approached the bus job.

I told the police officer with the woman that I would be right back to help her (after I had done a cursory check of her face). At this point I had no idea it was my regular friend on the bus but I weighed up the possibilities as I considered which call took priority. Drunk on a bus, woman with smashed up face...hmmm, difficult. The trouble was, I had been assigned the former and the latter was a running call.

I called my control and explained what was going on. They had just received the call about the lady with the facial injuries and were trying to assign an ambulance (but there weren’t any free) so I offered to deal with it after I had checked on the bus drunk. That’s when I walked onto the number 55 (or whatever it was) and saw his familiar and annoying face. The police were already onto him, so I agreed to leave him to them (after a quick check to see that he was just drunk and nothing else was wrong with him) and they took him off the bus and read him the riot act. He wasn’t arrested; he will never be arrested for this – it’s not worth the paperwork.

I went back to the injured lady and got her into the car, husband in tow and off we went to hospital. The last thing I saw of the annoying regular was the back of him as he shuffled off with the police watching him go.

I got the lady to hospital and found that there were no wheelchairs around, which is not unusual. She was too unsteady on her feet to walk and as I passed through the hospital corridor looking for something useful, I saw an item that shouldn’t have been there at all...a shopping trolley. It crossed my mind but I dismissed it.

Eventually I asked a crew if I could borrow their chair from the ambulance and they obliged. I handed her over and said goodbye. Then I made my way back to my own area.

We get messages direct from the police on our MDT’s now. I wasn’t aware of this because nobody told me but I discovered it when an ‘urgent update’ flashed up on the screen. It confused me at first because I didn’t know who had sent it or why but I read it: Drunk man back on another bus, been taken to hospital by ambulance crew.

The only thing worse than a time-wasting regular caller is one who knows exactly how to play the game.

Be safe.